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Reliability of seizure classification using a semistructured interview

G.H. Sergievsky Center, and Division of Epidemiology, School of Public Health (Drs. Ottman, Lee, Hauser, Hong, Hesdorffer, and Schupf), and the Department of Neurology (Drs. Hauser, Pedley, and Scheuer), Columbia University, New York; the Epidemiology of Brain Disorders Research Department (Dr. Ottman), New York State Psychiatric Institute, New York; and the Institute for Basic Research in Developmental Disabilities (Dr. Schupf), Staten Island, NY.

Methods for standardized classification of epileptic seizures are important for both clinical practice and epidemiologic research. In this study, we developed a strategy for standardized classification using a semistructured telephone interview and operational diagnostic criteria. We interviewed 1,957 adults with epilepsy ascertained from voluntary organizations. To confirm and expand the seizure history, we also interviewed a first-degree relative for 67% of subjects and obtained medical records for 59%. Three lay reviewers used all available information to classify seizures. To assess reliability, each reviewer classified a sample of subjects assigned to the others. In addition, an expert physician classified a sample of subjects assigned to two of the reviewers. Agreement was "moderate-substantial" for generalized-onset seizures, both for the comparisons between pairs of lay reviewers and for the neurologist versus lay reviewers. Agreement was "substantial-almost perfect" for partial-onset seizures, both for pairs of lay reviewers and for the neurologist versus lay reviewers. These results suggest that seizures can be reliably classified by lay reviewers, using operational criteria applied to symptoms ascertained in a semistructured telephone interview.

Address correspondence and reprint requests to Dr. Ruth Ottman, G.H. Sergievsky Center, Columbia University, 630 W. 168th Street, New York, NY 10032.

Supported by NIH R01-NS20656.

Received February 26, 1993. Accepted for publication in final form April 26, 1993.

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