Objectives: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Keywords: Auras; Epilepsy; Lateralisation; Localisation; Semiology.
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