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Development and validation of AIIMS modified INCLEN diagnostic instrument for epilepsy in children aged 1 month-18
Sheffali Gulati1, Harsh Patel1, Biswaroop Chakrabarty1
1Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029 India.
Insights
A modified epilepsy diagnostic tool for children aged 1 month to 18 years has been validated. This simple, accurate instrument is crucial for resource-limited settings lacking pediatric neurology specialists.
Area of Science:
- Pediatric Neurology
- Clinical Epidemiology
- Diagnostic Tools
Background:
- Shortage of pediatric epilepsy specialists, particularly in resource-limited areas, hinders timely diagnosis.
- Existing diagnostic tools, like the INCLEN instrument, have limitations in age range (2-9 years) and symptomatology coverage.
Purpose of the Study:
- To validate a modified INCLEN tool for diagnosing epilepsy in children.
- To expand the age range from 1 month to 18 years and include broader symptomatology.
- To provide a simple, structured, and accurate diagnostic instrument for resource-limited settings.
Main Methods:
- A modified INCLEN tool was developed, expanding age range and symptomatology.
- Validation occurred in a North Indian tertiary care hospital (January-June 2015).
- A qualified medical graduate applied the tool, followed by blinded expert evaluation by a Pediatric Neurologist.
Main Results:
- The study included 197 children (65% boys).
- The modified tool demonstrated high diagnostic accuracy: sensitivity 91.5%, specificity 88.6%.
- Positive predictive value was 89.7%, and negative predictive value was 90.8%.
Conclusions:
- The modified diagnostic instrument is simple, structured, and valid for children aged 1 month to 18 years.
- It offers acceptable diagnostic accuracy for use in resource-limited settings.
- The tool includes diverse seizure semiologies and common mimics, aiding accurate diagnosis.
Objectives:
There is shortage of specialists for the diagnosis of children with epilepsy, especially in resource limited settings. Existing INCLEN (International Clinical Epidemiology Network) instrument was validated for children aged 2-9 years. The current study validated modifications of the same including wider symptomatology and age group.
Methods:
The Modified INCLEN tool was validated by a team of experts by modifying the existing tools (2-9 years) to widen the age range from 1 month to 18 years and include broader symptomatology in a tertiary care teaching hospital of North India between January and June 2015. A qualified medical graduate applied the candidate tool which was followed by gold standard evaluation by a Pediatric Neurologist (both blinded to each other).
Results:
A total of 197 children {128 boys (65%) and 69 girls (35%)}, with a mean age of 72.08 (±50.96) months, completed the study. The sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio of the modified epilepsy tool were 91.5% (84.5-96.1), 88.6% (80.0-93.5), 89.7% (81.9-95.3), 90.8% (83.7-95.7), 8 (6.6-9.8) and 0.09 (0.07-0.12) respectively.
Significance:
The new modified diagnostic instruments for epilepsy is simple, structured and valid instruments covering 1month to 18 years for use in resource limited settings with acceptable diagnostic accuracy. All seizure semiologies as well as common seizure mimics like breath-holding spells are included in the tool. It also provides for identification of acute symptomatic and febrile seizures.