Introduction:  Epilepsy affects 50 million people worldwide, and is disproportionately prevalent in regions where specialist care and diagnostic tests are scarce. To improve diagnostic accuracy, we created a simple questionnaire with the aim to discriminate between focal versus generalized epilepsy, and guide medication choices.

Methods: Through literature review, key semiology features were identified. These were then validated by retrospective chart review in a Western tertiary care setting to identify 15 key questions. The refined questionnaire was translated into Kiswahili and validated prospectively in Tanzania. The performance of the questionnaire was compared to an electro-clinical diagnostic standard, from comprehensive clinical evaluation by a visiting pediatric neurology provider and locally obtained interictal EEG, read remotely.

Results:  Children aged 6 months to 18 years with suspected or active epilepsy were included. On retrospective validation, the overall predictive value of the questionnaire was 85%. Figure 1. During prospective validation, two questions were omitted as they translated poorly. The refined questionnaire had a positive predictive value of 78% for diagnosis of focal epilepsy, and 100% for generalized epilepsy. Table 1.

Discussion:  Our questionnaire provides a simple method to improve diagnostic accuracy, with the ultimate goal of guiding medication choices and improving treatment outcomes, with good predictive value in different health care settings.  It may help bridge the diagnostic gap in pediatric epilepsy in resource-limited regions, and once validated may be easily implemented in various forms for use by any pediatric healthcare provider.