The international classification of the epilepsies and epileptic syndromes- An algorithm for its use in clinical practice

An algorithm has been structured as a guided reading of the international l eague against epilepsy (ILAE) syndromic classification to be used in clinic al practice by less experienced physicians in newly diagnosed patients. The algorithm followed the original structure of the classification, which ide ntifies major syndromic groups, subgroups, and specific syndromes. Validati on required two raters, a resident and a board-certified neurologist, to ap ply the algorithm with different techniques (direct or recorded interview, medical record consultation) to 19 children and 18 adults with epilepsy wit h information available at the time of diagnosis. The two raters' diagnoses were compared with those of the caring physicians, and cases where disagre ement arose were discussed in conference to achieve consensus. The kappa st atistic was used as a measure of inter-rater agreement. Caring physicians a nd both raters agreed in 51% of cases. Substantial agreement (kappa = 0.75) was obtained between the resident and the neurologist on major diagnostic groups and subgroups, mostly in adults. Agreement with the caring physician was slightly more satisfactory for the resident (kappa = 0.67) than for th e neurologist (kappa = 0.60). Agreement was better with direct or indirect interview than with record consultation, and improved further after discuss ion. Agreement was obtained after discussion in 32% of cases, in some of wh ich the caring physician agreed on the resident's diagnosis. Agreement was less satisfactory for specific syndromes. On this basis, an algorithm of th e ILAE classification is a fairly reliable instrument only for making a bro ad syndromic classification of epilepsy at the time of diagnosis. The limit s of the algorithm tend mostly to reflect the intrinsic limitations of the classification itself. (C) 2000 Elsevier Science B.V. All rights reserved.