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Agreement Between a Questionnaire-Based Tool and Experienced Pediatric Neurologists in Classifying Seizure Types in
Puneet Kumar Choudhary1, Richa Tiwari1, Prabhjot Kaur1
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
A new questionnaire tool aids in broadly classifying epilepsy seizure types according to the International League Against Epilepsy (ILAE) 2017 guidelines. While effective for general categorization, detailed seizure classification requires further training.
Area of Science:
- Neurology
- Epilepsy Research
- Clinical Diagnostics
Background:
- Accurate epilepsy seizure type identification is vital for effective treatment and reducing patient morbidity and mortality.
- The International League Against Epilepsy (ILAE) 2017 classification system provides a standardized framework for categorizing seizures.
- Existing diagnostic tools may require enhancement to align with current classification standards.
Purpose of the Study:
- To develop a novel questionnaire-based tool for recognizing seizure types based on the ILAE 2017 classification.
- To evaluate the agreement between the developed tool and expert pediatric neurologists (PNs) in classifying seizure types.
Main Methods:
- Six questions were added to a validated epilepsy diagnostic instrument to cover all ILAE 2017 seizure types.
- Pediatric residents (PGs) and undergraduate interns were trained to use the tool for seizure classification.
- The tool's classifications were compared against those of three PNs using kappa agreement analysis.
Main Results:
- The study included 144 children with epilepsy.
- Kappa agreement between PGs and PNs was 0.52 (broad) and 0.28 (detailed).
- Kappa agreement between interns and PNs was 0.45 (broad) and 0.30 (detailed).
Conclusions:
- The questionnaire tool demonstrates appropriateness for broad seizure classification (generalized, focal, multiple, unclassified).
- Enhanced training may be necessary for achieving detailed seizure classification aligned with the ILAE 2017 system.
- The tool shows potential for assisting in initial seizure categorization in pediatric epilepsy management.
Background And Objectives:
Accurate identification of the seizure type and prompt initiation of appropriate treatment are crucial in reducing the morbidity and mortality associated with epilepsy. In this observational study, our objective was to develop a questionnaire-based tool to assist in recognizing seizure types based on the International League Against Epilepsy (ILAE) 2017 classification system. Additionally, the study assessed the level of agreement between pediatric neurologists (PNs) and this tool.
Methods:
Six additional questions were added to the existing, validated AIIMS modified International Clinical Epidemiology Network diagnostic instrument for epilepsy. These questions were designed to encompass all seizure types outlined in the ILAE 2017 classification scheme. Two pediatric postgraduate residents (PGs) and four undergraduate interns were trained to classify seizures using the tool. The classification of seizure semiology by PGs and undergraduate interns was performed verbatim using the tool. PNs used their clinical experience for seizure classification and served as the gold standard for comparison. The seizure classification by the tool was compared with the classification of three pediatric PNs using kappa agreement.
Results:
A total of 144 children (97 males) with confirmed epilepsy were enrolled. The kappa agreement between PGs and PNs was 0.52 at the first level (broad categorization of seizure type as per the ILAE classification) and 0.28 at the second level (detailed categorization of seizure type as per the ILAE classification). Between interns and PNs, the kappa agreement was 0.45 at the first level and 0.30 at the second level.
Conclusions:
The tool is appropriate for the broad classification of seizures into generalized, focal, multiple, and unclassified seizure types. However, for detailed seizure classification as per the ILAE 2017 classification, more extensive training may be required.
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