Validation of the International League Against Epilepsy (ILAE) Risk of Bias Tool against the Newcastle-Ottawa Scale in epilepsy research
Epilepsia. 2026 Mar 8. doi: 10.1002/epi.70183. Online ahead of print.
ABSTRACT
OBJECTIVE: Systematic reviews and meta-analyses (SRMAs) are critical for synthesizing evidence and guiding clinical and public health decision-making. This study aims to evaluate the reliability, validity and reproducibility of the International League Against Epilepsy (ILAE) Commission on Epidemiology Risk of Bias Tool by comparing it against the Newcastle-Ottawa Scale (NOS) to inform whether the ILAE tool may serve as a valid alternative in epilepsy-focused evidence syntheses.
METHODS: This study was planned a priori on three consecutive SRMAs. We assessed 54 observational studies included in these SRMAs focused on psychiatric comorbidities in persons with epilepsy. Eligible studies had ≥30 participants per group and validated criteria for diagnosing epilepsy and psychiatric conditions. Two independent raters scored all studies using both tools. The ILAE tool comprises six specific domains: (1) Source of Study Population; (2) Completeness (Sensitivity) of Epilepsy Case-Finding; (3) Sensitivity of Comorbidity Determination; (4) Accuracy of Epilepsy Diagnosis; (5) Accuracy of Comorbidity Diagnosis; and (6) Representativeness of Study Sample. Test-retest reproducibility used intraclass correlation coefficient (ICC). Correlation used Spearman’s rho. Agreement used weighted kappa. Bland-Altman analysis reported mean difference.
RESULTS: There was a strong positive correlation between NOS scores and ILAE ratings (Spearman’s rho = 0.80, 95% confidence interval [CI] 0.68-89, p < 0.001). Cohen’s weighted kappa was 0.68 (95% CI 0.37-0.92, p < 0.001). Bland-Altman mean difference was 0.09 with limits from -0.48 to 0.67, showing good agreement between tools. The ILAE tool showed excellent test-retest reproducibility (ICC 0.90, 95% CI 0.83-0.94).
SIGNIFICANCE: The ILAE tool demonstrated strong reliability and substantial agreement with the NOS while offering epilepsy specific rigor in diagnostic accuracy, sensitivity, case finding and representativeness. The ILAE tool offers a reliable, conceptually relevant, field-specific alternative for quality assessment in epilepsy SRMAs.
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