Preliminary Validation of the Epileptic Seizure Trigger Questionnaire for Perceived Seizure Triggers in Adults with Epilepsy

Background and Purpose: Seizure triggers-such as stress, sleep deprivation, and missed medication-are commonly reported by patients with epilepsy. Understanding these perceived triggers is critical for patient counseling and preventive strategies. However, no validated self-report instrument exists to systematically assess them. To develop and conduct a preliminary psychometric evaluation of the epileptic seizure trigger questionnaire (EST-Q).Methods: We conducted a cross-sectional study with 100 adults with active epilepsy recruited from two public hospitals in Rio de Janeiro, Brazil. The initial 12-item questionnaire was refined into an 11-item instrument after removing one poorly performing item. Psychometric evaluation was conducted exclusively on the seven-item core module, after exclusion of four items with high non-response rates. Analyses included exploratory and confirmatory factor analyses, internal consistency assessment, and item response theory (IRT). Given the modest sample size, confirmatory factor analysis and IRT findings were interpreted as exploratory and preliminary.Results: The seven-item core suggested a predominantly unidimensional structure (Kaiser-Meyer-Olkin=0.578; variance explained=29.7%), with borderline internal consistency (α=0.699; ω=0.681), which is adequate for group-level research but insufficient for individual clinical decisions, and moderate to high item discrimination. The four excluded items remain clinically relevant but were unsuitable for psychometric evaluation due to limited applicability.Conclusions: The EST-Q shows promise as a standardized tool for assessing perceived seizure triggers. These preliminary findings support its potential utility, but validation in larger, multicenter cohorts is needed to confirm its factor structure, reliability, and generalizability before routine clinical use.