Diagnoses made in a secondary care "fits, faints, and funny turns" clinic

Abstract

Aims: To investigate the diagnoses made for children referred to a ''fits, faints, and funny turns'' clinic. Methods: Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period. Results: Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a nonepileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment. Conclusions: In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non-epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non-epileptic cause are common and can be safely managed expectantly. E pilepsies of childhood can be confused with other intermittent unusual behaviours of varied cause. This contributes to the misdiagnosis of epilepsy, particularly its over-diagnosis. [1][2][3][4][5] This paper describes the diagnoses reached for children referred with ''fits, faints, and funny turns'' (FFAFT) to a dedicated secondary care clinic in a district general hospital over an eight year period (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). METHODSThe clinic received referrals from the local borough of Bury and some from surrounding districts. Referrals came from GPs, paediatricians, child psychiatrists, paediatric neurologists (usually for ongoing care), and acute hospital admissions. Referrals included those presenting for the first time with events, and those where a diagnosis of epilepsy had already been made but where further classification and management were required. The clinic did not care for all children with epilepsy in the district (for example, some of those with straightforward diagnoses or stable epilepsy); the data presented therefore cannot be compared directly with population based studies.Clinics were held weekly. The same clinician saw all the children (all age ,16 years) and made or confirmed most of the diagnoses. A record of the diagnoses was kept prospectively. Where diagnosis was unclear, further opinions from visiting paediatric neurologists were sought. Electroencephalograms (EEGs) were done at a tertiary centre (Royal Manchester Children's Hospital) and reported by paediatric neurologists.Diagnoses were made primarily on clinical information, sometimes augmented by home videos of events using a camcorder loaned by the clinic to families. Families were primed by a letter sent with the appointment asking them to bring a direct witnessed account of a typical event to the first consultation and details of any relevant family history. RESULTS Figure 1 present categories of diagnoses.New diagnosis of epilepsy Epilepsy was newly diagnosed in 89 children (50 boys and 39 girls) (fig 2). The median age of onset was 5 years (range 0...

Priorities in pediatric epilepsy research

“…Both errors carry consequences. In the first instance, children with nonepileptic events are mistakenly diagnosed as having epilepsy [26][27][28][29] and may be treated while the true underlying condition is not addressed. In the second case, the epilepsy diagnosis is missed.…”

Diagnoses and referral pattern at a first seizure clinic in London

“…In fact, a population based study in adults found a misdi-agnosis rate of 23% (Scheepers et al, 1998) and 26% of patients referred for "refractory epilepsy" were found not to have epilepsy at all (Smith et al, 1999). In children, the problem of misdiagnosis is even more relevant as a prospective study of more than 300 patients referred to a dedicated secondary care clinic showed that only 23% of children were given a final diagnosis of epilepsy (Hindley et al, 2006).…”

Management of Patients With Unclassified Epileptic Seizures in Outpatient Clinics in Spain. Results of the RETO Study

“…Within the definition of epilepsy, the ILAE recognizes several different types of epilepsy, such as partial or focal seizures, epilepsy with generalized onset, and unclassified epileptic seizures (Fisher et al, 2005). In studies that have used this classification, unclassified epileptic seizures accounted for 9.7% of newly treated epilepsy (Dupont, Marion-Audibert, Mechin, & Sevestre, 2006), and in newly diagnosed or untreated children with epilepsy, the proportion ranges from 4% (Carpay et al, 1998) to 9% (Hindley, Ali, & Robson, 2006).…”

“…An additional problem faced by practitioners is that other conditions may mimic epileptic seizures and so wrongly diagnosed as epilepsy. In a study of children referred to a clinic for "fits, faints and funny turns," only 23% were finally diagnosed with childhood epilepsy, whereas syncope was diagnosed in 48% of patients (Hindley, Ali, & Robson, 2006).…”