Validation of a focal seizure screening tool in Malaysia: A multicentre study

Accurate classification of seizure types guides diagnostic investigations and antiseizure medication (ASM) selection, and is particularly critical in resource-limited settings. We validated a pragmatic three-item focal seizure screening tool (aura, unilateral motor phenomena, oral automatisms) intended for rapid use by non-specialist clinicians.

Through a multicentre cross-sectional study spanning from 1 August 2024-31 August 2025, we recruited consecutive adults (≥18 years) with neurologist-confirmed seizure types at seven public hospitals in Malaysia. Clinicians applied the tool and finalized the scores (0-3). Diagnostic accuracy was evaluated using receiver operating characteristic analysis and area under the curve (AUC). Sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), and negative predictive value (NPV) were calculated at every cut-off score, respectively.

Among the 428 participants (mean age 36.4 ± 14.6 years), 83.41% had focal seizures. The tool achieved an AUC of 0.751 (95% CI 0.688-0.815; p < 0.001). A cut-off score of ≥ 1 yielded high sensitivity (84.0%) and fair specificity (59.2%), with LR + of 2.06 and PPV of 91.19%, supporting its role for screening. A cut-off score of ≥ 2 improved specificity to 88.73% and PPV to 94.74%, making it suitable for diagnosis.

The three-item focal seizure screening tool is feasible, rapid to administer, and may assist general clinicians in classifying focal-onset seizures. Cut-off scores can be selected according to clinical priorities, namely, sensitive case-finding versus high-specificity confirmation.