A STRUCTURED QUESTIONNAIRE IMPROVES ACCURACY OF SEIZURE REPORTS

1. A STRUCTURED QUESTIONNAIRE IMPROVES ACCURACY OF SEIZURE REPORTS Hemang Shah*; Nancy McNair*; J. Ned Pruitt*; Susan Strickland*; Sabina Miranda*; Anthony Murro*; Duchwan Ryu**; Yong Park* * Department of Neurology and **Biostatistics, Medical College of Georgia, GHSU, Augusta, GA RESULTS: This prospective study recruited 92 subjects, 35 women and 57 men; 2 subjects did not report their gender. Among the subjects, 24 (25%) had seen a prior seizure, and 21 (22%) knew a person with epilepsy. We evaluated the statistical significance of all findings with a Fisher Exact Test except where specifically mentioned otherwise. The subjects were better able to identify the events as seizures with the structured questionnaire as compared to the unstructured questionnaire (p<0.0001). This improvement was greater for the GTCS video as compared to the CPS video (p<0.0001). Subjects reported the duration of the seizures more frequently with the structured questionnaire as compared to the unstructured questionnaire (p<0.0001); but the structured questionnaire did not improve the accuracy of the reported seizure duration. The structured questionnaire also increased the identification of specific seizure features such as the automatism (p<0.05 based on chi-square, signed rank test), and ictal vocalization (p<0.01). Subjects who had seen a prior seizure or who knew someone with epilepsy were not more likely to recognize the events as seizures. RATIONALE: Health care providers commonly rely on eyewitness accounts for seizure diagnosis. Open ended questions might fail to elicit the information needed for the correct diagnosis. The purpose of this study was to determine the effectiveness of a structured questionnaire for obtaining accurate information needed for seizure diagnosis. METHODS: Third year medical students were recruited as study subjects from April, 2010 to May, 2011. The subjects viewed 2 videos in small group session, during their neurology rotation (total 184 videos=n). The subjects were not informed in advance that the videos recorded seizures. The first video recorded a 43 second convulsive seizure in a person with juvenile myoclonic epilepsy. During the seizure, myoclonus, an ictal vocalization, and generalized tonic-clonic seizure (GTCS) occurred. The second video recorded a 63 second medial temporal lobe complex partial seizure (CPS). During this seizure, arrest of activity, oral automatisms, and manual automatisms occurred. At the end of 2 videos, the subjects received an unstructured questionnaire followed by a structured questionnaire. The unstructured questionnaire requested the subjects to "Describe what you see in the video." Next, the structured questionnaire requested the subjects to respond to 9 multiple choice questions for each video recording. The subjects also reported their gender, if they had seen a seizure previously, and if they knew someone who had epilepsy. Chart: 1: Structured Questionnaire 2: Unstructured Questionnaire Series 1: Subject Identified Event as a Seizure Series 2: Reported Duration of Seizure Figure 1: Patient with Juvenile Myoclonic Epilepsy during a Generalized Tonic Clonic Seizure. CONCLUSIONS: A structured questionnaire significantly improved the ability of a witness to correctly identify an event as a seizure and identify specific features of the seizure. A structured questionnaire would complement other data sources such as open ended questions, and home video recordings of seizures. Use of the structured questionnaire by family members could provide more accurate representations of seizure activity at home, and help health care providers better determine how seizures occurring in the hospital compare to seizures occurring at home. Figure 2: Patient with Temporal lobe epilepsy during a Complex Partial Seizure.