Abstracts

Rationale: Motivation: The INSET (Inventory of Neppe of Symptoms of Epilepsy and the Temporal Lobe) is a major clinical starting-point for eliciting more pertinent, relevant, history-taking detail on seizures, peri-ictal symptoms, and temporal lobe features. No other adequate standardized, brief, historical bedside or waiting-room questionnaire apparently screens for "possible temporal lobe symptoms" (PTLSs) plus seizure-like symptoms. The INSET fills a great void in epileptology, neuropsychiatry, behavioral neurology, psychiatry, neurology and neuropsychology. It provides standardized detail: Symptom interpretations are based on the literature. Historicity: Vernon Neppe, in 1977 in South Africa, developed an earlier version: The Neppe Temporal Lobe Questionnaire (NTLQ). He adapted it (U.Washington, 1986-1992) and thereafter made improvements for its routine, essential use at the Pacific Neuropsychiatric Institute (PNI)(1992-present). Comparisons: Several researchers and clinicians have adapted the INSET, but the INSET apparently remains the most clinically comprehensive, user-friendly, critically important, and pertinent screen. Neppe's "Long INSET" also exists but is seldom used because it is time intensive. Procedure: Patients usually take ½ -1 hour to complete the INSET: Clinicians thereafter consult more quickly, easily, and fully evaluate the standardized answers, amplifying the clinically pertinent symptoms. Diagnostic utility: The INSET and Ambulatory Electroencephalography (AEEG) together facilitate anticonvulsant choices because missing anticonvulsant responsive patient subpopulations are identified and differentiated from those mislabeled with "seizures" or temporolimbic instability. Indications: The INSET should be used routinely clinically. Its easy scoring facilitates use by those with limited clinical expertise in psychiatry and epileptology. It can also educate students to differentiate symptoms. Use: The regular INSET use over two decades, attests to its value, e.g., since 1992, every neuropsychiatric and "rule-out" seizure patient at the PNI has completed it. The INSET, in addition, has medicolegal (forensic) applications. Methods: For the first time, we analyze and statistically quantify, as applicable, a patient sample for construct, internal and face validity, and reliability of the INSET. Comparative constructs include 3-day AEEG, anticonvulsant responsiveness, quantitative clinical improvement measures, comparisons with "control" patients, and comparing pertinent parts of a related, but also used different, independent historical screen, the "SOBIN" (Subtle Organic Brain Inventory of Neppe), which has useful overlapping and amplifying features, plus neuropsychiatric symptom screens, including for headache, anger, depression, anxiety, fatigue, sleepiness, and functioning. Results: Analyses are performed. Conclusions: This confirms the utility of the INSET.