A.06 Assessing inter-rater reliability in localizing sleep-related hypermotor seizures: a video-based survey

Background: Sleep-related hypermotor epilepsy (SHE) is a focal epilepsy characterized by abrupt sleep-related hypermotor seizures (SRHS) with complex semiology. Although difficult to localize within the frontal lobe recent studies using intracerebral EEG recordings have suggested the existence of four distinct semiology patterns (SP) organized in a rostro-caudal manner. It remains unclear however if these SP are clinically useful. Methods: We aimed to estimate the inter-rater reliability (IR) of classifying SP in SHE amongst epilepsy and sleep medicine experts. Following a short training session, ten experts were asked to review and classify 40 videos of SRHS in patients with confirmed SHE. IR was calculated using Kappa statistics. Results: SP1 and SP4, who are at the opposite ends of the SHE semiology spectrum, had substantial IR (0.82 and 0.67, respectively). Meanwhile, SP2 and SP3 showed fair agreement (0.25 and 0.35, respectively) and represented the major source of variance, with a small difference favouring epilepsy experts. Conclusions: Amongst epilepsy and sleep medicine experts, IR of classifying SRHS into four SP was only mildly satisfactory. SP1 and SP4 were shown to be easily recognizable while SP2 and SP3 were frequently confounded. Improvements in SP recognition are needed before widespread clinical use.