Evaluate the feasibility of Seizure ROAR testing for behavioral testing during video electroencephalography (vEEG).

Behavioral assessments during vEEG are crucial in seizure localization and semiology, yet, there is not a 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. Ictal ROAR components include remembering a word, identifying an object, performing an action, and reading a sentence. The post-ital ROAR components are to recall the word provided, answer an orientation question, presence or absence of an aura, and read a sentence. 

This retrospective study evaluates feasibility of ROAR behavioral testing while on vEEG. We reviewed 200 events of Epilepsy Monitoring Unit (EMU) patients from 2018-2023 to determine the feasibility of the protocol. Data was entered into a RedCap database. 

The mean age of the participants included in the study was 37 with 73% females, 41% had diagnoses of psychogenic non-epileptic spells, and 59% had epilepsy. 

Our preliminary findings indicate that Ictal ROAR testing was initiated 62% of the time, yet only 15% had full completion of ictal testing questions. Similarly, post-ictal ROAR testing was initiated 60% of the time but had 0% completion rate. The median time to initiate ictal and postictal ROAR was 81s and 95s respectively. Notably, the seizure ROAR protocol demonstrated applicability to various seizure types, including focal, generalized, and non-epileptic events.

While several testing protocols are available, our study reviews the feasibility of the ROAR ictal and postictal based on our institutional experience. This protocol is likely to be initiated 60% of time, however, not all components are asked. Further research is needed to test ROAR protocol reliability and establish standardized behavioral testing during vEEG, ultimately contributing to improved diagnostic accuracy and patient care in epilepsy management.