title: Attributing seizures to TBI: Validation of a brief patient questionnaire.
abstract: OBJECTIVE
  Traumatic brain injury (TBI) is an important cause of epilepsy and has also been associated with psychogenic nonepileptic seizures (PNES). We designed a brief questionnaire assessing patient beliefs regarding TBI as the cause of their seizures (Patient Seizure Etiology Questionnaire; PSEQ). This study reports content validity for the PSEQ.
  
  
  METHODS
  Ninety Veterans undergoing comprehensive evaluation at 3 VA epilepsy centers completed the PSEQ, a series of questions regarding possible causes for their seizures, including TBI. The PSEQ was scored as YES vs. NO for TBI as the proposed cause of seizures. For each patient, two expert reviewers independently completed a structured chart review to determine whether TBI was the proposed cause of seizures (n=180 reviews). Kappa statistic was used to assess agreement between the PSEQ and each chart review and between the PSEQ and combined chart reviews where both reviewers agreed on a TBI seizure etiology.
  
  
  RESULTS
  The PSEQ scored higher overall rates for a TBI seizure etiology than did expert chart reviews (40% vs. 28%; p<0.001). The PSEQ agreed with 82% of 180 independent chart reviews (sensitivity 88%; specificity 79%). Kappa statistic for agreement was 0.60. The two reviewers agreed on a probable TBI seizure etiology for 83% of chart reviews. The PSEQ sensitivity increased to 100% when both reviewers were in agreement.
  
  
  CONCLUSIONS
  The PSEQ provides a direct, standardized measure of patient beliefs regarding TBI as the cause of their seizures and has moderate-substantial agreement with expert chart reviews.
authors.affiliation: Portland Veterans Affairs Medical Center, Portland, OR, United States; Oregon Health & Sciences University, Portland, OR, United States. Electronic address: Salinsky@ohsu.edu.
authors.forename: Martin
authors.initials: M
authors.lastname: Salinsky
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Parko
authors.affiliation: William S. Middleton Veterans Affairs Medical Center, Madison, WI, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Rutecki
authors.affiliation: Portland Veterans Affairs Medical Center, Portland, OR, United States; Oregon Health & Sciences University, Portland, OR, United States.
authors.forename: Eilis
authors.initials: E
authors.lastname: Boudreau
authors.affiliation: Portland Veterans Affairs Medical Center, Portland, OR, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Storzbach
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000209:etiology; D004827:Epilepsy / Q000150:complications / Q000523:psychology; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012640:Seizures / Q000150:complications* / Q000523:psychology; D012680:Sensitivity and Specificity; D013001:Somatoform Disorders / Q000523:psychology; D011795:Surveys and Questionnaires / Q000592:standards*; D014728:Veterans
keywords: Epilepsy; Psychogenic seizures; TBI; Veterans