Clinical Implementation of a Parent Questionnaire to Identify Seizures in High-Risk Children

Shining a Light: Advancing Health Equity in Overlooked Epilepsy Communities

Achieving equitable health in epilepsy requires addressing systemic barriers and social determinants of health to ensure that every person with epilepsy has the opportunity to attain their highest level of health. We review the literature on disparities that affect several minoritized groups living with epilepsy. Early solutions with the potential for modeling towards replication for low socioeconomic status population, non-English language preference communities, sexual and gender minorities, and rural and underserved communities with high social determinants of health burden are shared as examples to catalyze stakeholder investment in identifying and addressing health disparities across the spectrum of epilepsy at both the provider and health systems level. Further support for innovative research is needed to better delineate epilepsy prevalence, treatment access, and health outcomes among diverse populations. These data are essential for enabling the development and testing of evidence-based approaches that lessen disparities and support health equity for individuals impacted by epilepsy.

Socioeconomic disparities in epilepsy care

PURPOSE OF REVIEW

Epilepsy is a common, chronic neurologic disease with continued disparities in care. The COVID-19 pandemic and recent social movements have drawn greater attention to social determinants of health and our progress (or lack thereof) toward delivering more equitable care.

RECENT FINDINGS

Recent studies continue to document racial and economic disparities in diagnosis, treatment, and overall care of epilepsy and associated conditions. Notably, an increasing number of studies are attempting to design healthcare pathways and other interventions to improve access and equity in epilepsy care.

SUMMARY

The present literature highlights the importance of identifying and addressing the particular needs of vulnerable persons with epilepsy. Practitioners and researchers should continue to develop interventions aimed at improving care for all patients and, crucially, measure the impact of their changes to ensure that any interventions are truly advancing health equity.

A Novel Parent Questionnaire for the Detection of Seizures in Children of Spanish-Speaking Families

BACKGROUND

We developed and validated a Spanish seizure screen for children based on a previously validated English seizure screen that could be administered by a trained research assistant in a 2-step process, approximating the clinical diagnostic process of a pediatric epilepsy specialist. This questionnaire was designed to study seizure prevalence in a research population of children at risk for epilepsy.

METHODS

Spanish-speaking parents of children 6 months to 17 years old were recruited from the pediatric neurology clinics at Boston Medical Center and interviewed using a computerized questionnaire. A computerized algorithm of parent responses rendered a seizure classification of positive or negative. Blinded to questionnaire results, pediatric neurologists served as the diagnostic gold standard, ranking each patient event using a 4-level scale based on clinical history and examination: (1) not likely, (2) indeterminate, (3) probable, and (4) almost certain where rankings of 3 or 4 lead to a diagnosis of seizure.

RESULTS

The questionnaire was completed by 163 enrolled parents. The seizure screen demonstrated a 94.2% sensitivity and 93.7% specificity for identifying seizures. The positive predictive value was 87.5%, and the negative predictive value was 97.2%.

CONCLUSIONS

This pediatric seizure questionnaire was both sensitive and specific for detecting clinically confirmed seizures. This tool may be useful to clinicians and researchers in screening large populations of children, decreasing the time and cost of added neurologic assessments.