Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty

Abstract

The diagnosis of first seizure or epilepsy may be challenging and misdiagnosis can occur. Studies carried out in various settings have reported misdiagnosis rates of between 4.6% and 30%. Misdiagnosis can lead to serious consequences including driving and employment restrictions and inappropriate treatments. Most studies focus on ways of reducing misdiagnosis. However, in some cases, it may be difficult to make a definite diagnosis at initial presentation. This is because of a number of reasons including overlapping clinical features with other conditions, inadequate available history and limitations of investigations. Consequently, diagnostic uncertainty is inevitable in epilepsy, although few studies acknowledge this. In this paper we review the literature on misdiagnosis rates, analyse reasons for misdiagnosis and consider limitations of available investigations. We propose that diagnostic uncertainty in epilepsy should be more widely acknowledged and addressed, and that this may reduce misdiagnosis rates.

Potential Misdiagnoses of Bell's Palsy in the Emergency Department

“…16 Similarly, for other dangerous neurologic conditions, higher rates of incorrect diagnoses have been reported for central vertigo, 17,18 spinal cord compression, 19 transient ischemic attack, 20 GBS, 21 and seizures. 22 …”

The role of companions in outpatient seizure clinic interactions: A pilot study

“…However, patients with seizures are routinely invited to bring along a companion when they attend outpatient appointments. National guidelines and studies focusing on the risk of misdiagnosis underline the importance of obtaining descriptions not only from patients but also from witnesses of attacks [11][12][13][14].…”

Video-based training improves the accuracy of seizure diagnosis

“…Differentiating epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES) is a major diagnostic challenge. The reported rate of misdiagnosis of PNES as epilepsy ranges from 20% to 26%,5 and the average delay in diagnosing PNES has been reported to be as long as 7–9 years 3 4. The misdiagnosis of PNES as epilepsy is associated with potentially deleterious consequences, such as unnecessary interventions (intubation, ventilation, central venous lines, intensive care),1 6 inappropriate prescribing of antiepileptic medications, expensive investigations, frequent hospital visits, financial loss to the individual, healthcare system and society at large,4 7 and even rare cases of death due to unnecessary treatment 8.…”