Agreement Between a Questionnaire-Based Tool and Experienced Pediatric Neurologists in Classifying Seizure Types in Children with Epilepsy

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.