Department of Child Health, Dr. Cipto Mangunkusumo National Hospital-Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Department of Child Health, Fatmawati General Hospital, Jakarta, Indonesia.
Epilepsia Open. 2024 Oct;9(5):1868-1880. doi: 10.1002/epi4.13021. Epub 2024 Aug 7.
To outline the preliminary development and validation of a questionnaire for diagnosing epilepsy and distinguishing focal and generalized epilepsy among infants and children in Indonesia, where electroencephalography and pediatric neurologists are generally not available.
A 10-question questionnaire comprising of 43 items was developed through literature review and expert panel discussions. Then, the questionnaire was administered by pediatricians to 75 children aged 1 month to 18 years old presenting with >1 episode of unprovoked seizures at an interval of >24 h. Subsequently, the questionnaire was assessed for content validity with item-level and scale-level content validity indices and ratio, construct validity with item-total correlation tests, criterion validity with diagnostic parameter assessments, and inter-rater reliability using Cohen's kappa (κ) and internal consistency with Cronbach's alpha (α) coefficient.
The questionnaire exhibited favorable internal validity and reliability in diagnosing epilepsy and distinguishing focal and generalized epilepsy, with excellent content (both indices and ratio at 1) and construct validity (r > r at p < 0.001), inter-rater reliability (κ = 0.86 and κ = 0.84), and internal consistency (α = 0.634 and α = 0.806). The questionnaire had a sensitivity and specificity of 96.4% (95%CI 89.1-99.5%) and 95.0% (79.5-99.6%) (area under the curve [AUC] 0.946 [0.900-0.992, p < 0.001]) in diagnosing epilepsy and 80.0% (57.4-95.7%) and 97.4% (89.7-99.2%) (AUC 0.889 [0.783-0.995, p < 0.001]) in distinguishing focal and generalized epilepsy, with a misdiagnosis rate of 4.0%.
The questionnaire shows promising potential in diagnosing epilepsy and distinguishing focal and generalized epilepsy. Further external validation studies in larger and more diverse populations are required to confirm our findings.
The diagnosis of epilepsy in children is challenging, particularly in resource-limited settings such as Indonesia, where advanced diagnostic tests and pediatric neurologists are scarce. The Indonesian Pediatric Epilepsy Questionnaire (INA-PEPSI) is designed to address these limitations by enabling healthcare professionals in Indonesia to diagnose epilepsy and classify its types without relying on advanced diagnostic tools. Although the questionnaire is still in the early stages of development and validation, this study demonstrates that the questionnaire exhibits good overall diagnostic performance in diagnosing epilepsy and distinguishing epilepsy types among Indonesian children.
描述一种用于诊断印度尼西亚婴儿和儿童癫痫症并区分局灶性和全面性癫痫的问卷的初步开发和验证，因为在那里通常无法进行脑电图和儿科神经科医生检查。
通过文献回顾和专家小组讨论，制定了一个包含 43 个项目的 10 个问题的问卷。然后，由儿科医生对 75 名年龄在 1 个月至 18 岁之间、间隔 >24 小时发作 >1 次无诱因癫痫发作的儿童进行问卷调查。随后，使用项目层面和量表层面的内容有效性指数和比值、项目总分相关性检验、诊断参数评估的构效关系、Cohen's kappa（κ）的组内一致性检验和 Cronbach's alpha（α）系数的内部一致性检验来评估问卷的内容有效性。
该问卷在诊断癫痫症和区分局灶性和全面性癫痫症方面表现出良好的内部有效性和可靠性，具有极好的内容（均为 1）和构效关系（r＞r，p＜0.001）、组内一致性（κ＝0.86 和 κ＝0.84）和内部一致性（α＝0.634 和 α＝0.806）。该问卷在诊断癫痫症方面的灵敏度和特异性分别为 96.4%（95%CI 89.1-99.5%）和 95.0%（79.5-99.6%）（曲线下面积[AUC]0.946 [0.900-0.992，p＜0.001]），在区分局灶性和全面性癫痫症方面的灵敏度和特异性分别为 80.0%（57.4-95.7%）和 97.4%（89.7-99.2%）（AUC 0.889 [0.783-0.995，p＜0.001]），误诊率为 4.0%。
该问卷在诊断癫痫症和区分局灶性和全面性癫痫症方面具有很大的潜力。需要在更大、更多样化的人群中进行进一步的外部验证研究，以证实我们的发现。
