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INTRODUCTION

OBJECTIVE

METHODS

CONCLUSIONS

Evaluate the feasibility of the Seizure ROAR © testing protocol for behavioral testing during vEEG.

ROAR © protocol was initiated ~65% of the time, with full completion rate of 22% and 3.5% for ictal & post-ictal ROAR respectively.
It is applicable in various seizure types with reasonable completion rates.
Ongoing education/training for staff can improve the execution and completion of ROAR as studies show that more training is helpful (1)

Feasibility of Behavioral Testing during Video EEG Monitoring with Seizure ROAR©

Testing Protocol

Amerta Bai¹, Lisa Lykken¹, Paul Wang¹, Eric Waldron¹, David Darrow¹, Tariq Hattab¹, Melissa Mueller ², Megan Halverson², Thomas R. Henry¹, Sima Patel¹

Department of Neurology, University of Minnesota, Minneapolis; Fairview Practice and Education

Behavioral assessments during video electroencephalogram (VEEG) are crucial in seizure localization and semiology, yet, there is no standardized tool widely utilized.
At our center, we have utilized the ROAR© protocol since 2012 and have received positive feedback from our multidisciplinary team for ease of use and applicability.
Nursing staff only received 20 minutes of online training once during their onboarding for ROAR© testing.

RESULTS

ICTAL ROAR	POST-ICTAL ROAR
“R” Remember a word	“R” Recall the word and object
“O” Remember an Object	“O” Ask Orientation questions
“A” Perform an Action	“A” Ask about Aura/ typical spell
“R” Read a sentence	“R” Read a sentence

Spell type	Completion rate (ICTAL)	Completion rate (POST-ICTAL)
PNES	52.25%	35%
GTS	45%	30%
GTCS	13.89%	16.65%
FAUWOM	48%	25%
FAUWM	40%	24.5%
FIAWOM	50%	34%
FIAWM	55.4%	31%

Age	~41yrs (Median)
Sex	66% Females
Race	85% white
Diagnosis	26% PNES
Spell type	54% non-epileptic

DEMOGRAPHICS

COMPLETION RATES OF ROAR TESTING (GENERAL)

FUTURE DIRECTIONS

Further research is needed to test ROAR’s inter-rater reliability to improve diagnostic accuracy and patient care in epilepsy evalution.

REFERENCES

(1)Wulf JA. Evaluation of seizure observation and documentation. J Neurosci Nurs. 2000;32(1):27-36. doi:10.1097/01376517-200002000-00008

Patients and Data:

Retrospective study
Reviewed 200 events of Epilepsy Monitoring Unit

(EMU) patients from 2018-2023

Data was entered into a RedCap database.

Statistical analysis:

Descriptive statistics were calculated for:

Demographic data
Diagnosis and spell type
Median time to initiate ictal and postictal ROAR
Completion rates for both ictal and postictal testing
Completion rates for each seizure type

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PNES: Psychogenic non-epileptic spells, GTS: Generalized tonic seizures, GTCS: Generalized tonic-clonic seizures, FAUWOM: Focal aware unimpaired without motor, FAUWM: Focal aware unimpaired with motor, FIAWOM: Focal impaired awareness without motor, FIAWM: Focal impaired awareness with motor

COMPLETION RATES FOR EACH SEIZURE TYPE

MEDIAN TIME TO INITIATE TESTING

ICTAL ROAR	POST- ICTAL ROAR
68s	96s