Sheffali Gulati1, Harsh Patel2, Biswaroop Chakrabarty2, Rachana Dubey2, N K Arora3, R M Pandey4, V K Paul5, Konanki Ramesh6, Vyshakh Anand5, Ankit Meena5. 1. Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029 India. Electronic address: sheffalig@yahoo.com. 2. Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029 India. 3. INCLEN Trust, New Delhi, India. 4. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. 5. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. 6. Rainbow Children Hospital, Hyderabad, India.
Abstract
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.
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.
Authors: Narendra K Arora; M K C Nair; Sheffali Gulati; Vaishali Deshmukh; Archisman Mohapatra; Devendra Mishra; Vikram Patel; Ravindra M Pandey; Bhagabati C Das; Gauri Divan; G V S Murthy; Thakur D Sharma; Savita Sapra; Satinder Aneja; Monica Juneja; Sunanda K Reddy; Praveen Suman; Sharmila B Mukherjee; Rajib Dasgupta; Poma Tudu; Manoja K Das; Vinod K Bhutani; Maureen S Durkin; Jennifer Pinto-Martin; Donald H Silberberg; Rajesh Sagar; Faruqueuddin Ahmed; Nandita Babu; Sandeep Bavdekar; Vijay Chandra; Zia Chaudhuri; Tanuj Dada; Rashna Dass; M Gourie-Devi; S Remadevi; Jagdish C Gupta; Kumud K Handa; Veena Kalra; Sunil Karande; Ramesh Konanki; Madhuri Kulkarni; Rashmi Kumar; Arti Maria; Muneer A Masoodi; Manju Mehta; Santosh Kumar Mohanty; Harikumaran Nair; Poonam Natarajan; A K Niswade; Atul Prasad; Sanjay K Rai; Paul S S Russell; Rohit Saxena; Shobha Sharma; Arun K Singh; Gautam B Singh; Leena Sumaraj; Saradha Suresh; Alok Thakar; Sujatha Parthasarathy; Bhadresh Vyas; Ansuman Panigrahi; Munish K Saroch; Rajan Shukla; K V Raghava Rao; Maria P Silveira; Samiksha Singh; Vivek Vajaratkar Journal: PLoS Med Date: 2018-07-24 Impact factor: 11.069