Utility of a questionnaire tool (QUARAS) for localizing and lateralizing seizures in the epilepsy monitoring unit (EMU)

• Published in: Clinical neurology and neurosurgery Vol. 153; pp. 64 - 66
• Main Authors: Chaudhari, Rima M., Ramanujam, Bhargavi, Appukuttan, Renjith, Sharma, Anubha, Kunwar, Yuvraj, Tejaniya, Gaurav, Garg, Ajay, Padma, Madakasira Vasantha, Tripathi, Madhavi, Bal, Chandrashekhar, Dash, Deepa, Chandra, Sarat P., Tripathi, Manjari
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2017; Elsevier Limited
• Subjects: Adult; Auras; Caregivers; Classification; Dialects; Drug Resistant Epilepsy - diagnosis; Education; Epilepsy; Humans; India; Lateralisation; Localisation; Localization; Neurology; Neurosurgery; NMR; Nuclear magnetic resonance; Patients; Phenomenology; Questionnaires; Seizures - diagnosis; Semiology; Semiotics; Surgical outcomes; Surveys and Questionnaires; Young Adult; India; Auras; Localisation; Lateralisation; Epilepsy; Semiology
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2016.12.012

•Aura and semiology of seizures elicited by routine history-taking.•Questionnaire tool for aura and semiology also administered to same patients(n=139).•Localization and lateralization determined at each step in a blinded manner.•Both separately compared to final hypothesis of the epileptogenic zone (EZ).•Questionnaire had significantly higher yield of auras, concordance with EZ. An accurate description of the seizure semiology improves the recognition of the ictal onset zone and helps in hypothesizing the possible epileptogenic zone (EZ). Semiology based on a reliable description of seizures may be as good as investigative modalities, as has been shown by numerous studies. The main objective of this study was to apply a questionnaire-tool for auras and semiology (QUARAS) in refractory epilepsy cohort and compare its yield to that of standard history-taking. A drug refractory epilepsy cohort of 139 subjects was selected, based on inclusion and exclusion criteria. All subjects underwent routine history-taking, and a structured interview with QUARAS (in Hindi language) about 3–6 months later when they were admitted for pre-surgical work-up (Video-EEG, MRI, SPECT and PET), by an epilepsy nurse. Seizures were localised and lateralised at the each step separately, in a blinded manner; concordance with the final hypothesis was checked, after the epilepsy-surgery case-conference, and statistical significance of the difference calculated. Auras were reported in significantly more number of patients after administration of QUARAS (p<0.001); there was also higher concordance between the final hypothesis and the localization and lateralization based on QUARAS than an unstructured history (p<0.001). Administering a structured questionnaire in the native language of patients by trained personnel leads to better localisation and lateralisation and may help arrive at a hypothesis about the EZ.