Validation of Diagnostic Criteria for Major Seizures at the Community Level and in a Hospital Setting

Abstract

An estimated 35 million persons with epilepsy today live in developing countries. The diagnosis of some types of epilepsy is complex and requires a high level of sophistication on the part of physicians specializing in neurosciences, supported by high-technology laboratory tests. Conversely, identification of major seizures (grand mal seizures, estimated to account for ∼60–70% of all epilepsy cases) is possible by simple observation of a seizure without the help of EEGs, computed tomography (CT), and magnetic resonance imaging (MRI) scans. The major seizures have the highest morbidity and a good outcome if treated early with easily available and effective antiepileptic drugs (AEDs). A questionnaire consisting of three screening and 14 supplementary questions is being used by trained health care workers to conduct a survey among population living in rural and semiurban areas. The suspected cases with major seizures (based on information gathered from a person who has witnessed at least one major seizure) are being confirmed or excluded in a blinded manner by a trained neurologist. Additionally, patients confirmed to have epilepsy in a tertiary care superspecialty hospital (based on EEGs, CT, and/or MRI scans), pseudoseizures (using video-EEGs), and common nonepilepsy CNS disorders also are being investigated in a blinded manner based on information gathered from an eyewitness, relatives, and from adult patients. The data collected will be analyzed with an aim to validate the questionnaire for use in surveys planned to be conducted in community and hospital settings in other countries of the Southeast Asian Region of the WHO.