Preventing misdiagnosis of epilepsy

Ferrie, Colin D.

doi:10.1136/adc.2005.088906

Cited by 64 publications

(39 citation statements)

References 14 publications

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“…Indeed, many patients misdiagnosed as having epilepsy have had previous EEGs interpreted as epileptiform [24,25,26,27]. The problem of overread EEGs is well known by epileptologists, who generally agree that overreading is much more deleterious than underreading [28,29,30].…”

Section: Introductionmentioning

confidence: 99%

Errors in EEG Interpretation and Misdiagnosis of Epilepsy

2008

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Background/Aims: The overinterpretation of EEGs is common and is an important contributor to the misdiagnosis of epilepsy. We reviewed our experience in order to clarify which EEG patterns are commonly overread as epileptiform. Methods: We identified patients who were seen at our epilepsy clinic and were ultimately diagnosed as having conditions other than epilepsy. We selected those who had previously had an EEG read as showing epileptiform discharges and whose EEG was available for our own re-review. Results: 37 patients met the above criteria. Eventual diagnoses were psychogenic nonepileptic seizures (10), syncope (7), other miscellaneous diagnoses (5) and unexplained nonspecific symptoms (15). None of the EEGs had epileptiform discharges. The descriptions of the abnormalities included ‘temporal sharp waves’ in 30, ‘frontal sharp waves’ in 2 and ‘generalized spike-wave complexes’ in 2. Three had no reports available to identify the alleged abnormality. The benign patterns mistaken for temporal (30) and frontal (2) sharp waves were simple fluctuations of background activity with temporal phase reversals. Conclusions: By far the most common patterns overread as epileptiform are nonspecific fluctuations of background in the temporal regions, which are misread as temporal sharp waves.

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Section: Introductionmentioning

confidence: 99%

Errors in EEG Interpretation and Misdiagnosis of Epilepsy

2008

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“…Ancak çeşitli sebeplere bağlı olarak hatalı tanı farklı kaynaklarda %20-30 oranında bildirilmektedir. [14] Hastada nöbetin gözlenmesi tanı hatalarını azaltacak bir uygulamadır. Bu uygulamanın zorluğu ise nöbetlerin ne zaman ortaya çıkacağının belirsizliğidir.…”

Section: Gereç Ve Yöntemunclassified

An approach to epilepsy patients admitted to hospitalization for the purpose of disability determination

Buluş¹

2015

Epilepsi

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SummaryObjectives: In this retrospective study, it was aimed to share the experience gained in Cerrahpaşa Medical Faculty, Department of Neurology regarding a 15 (or 21)-day of observation of epilepsy patients referred by the Social Security Institution (SSI) in an attempt to identify their rate of disability and question the practicality and validity of this practice. Methods: Fifty-eight patients, referred to our clinic and hospitalized for the purpose of determining the disability rate between 2007 and 2014, were retrospectively analyzed. Results: Fifty-eight patients (10 female, 48 male) were included into our study. The number of patients with refractory epilepsy was 18 (33.3%). Twenty-seven cases had witnessed seizures during hospitalization and 11 of these patients were evaluated with psychogenic seizures. We were unable to witness seizures in eight cases. Of the fifty-eight patients, 65.5% of them (n=38) were diagnosed with epilepsy, 20.6% of them (n=12) were psychogenic non-epileptic seizures (PNES) and epilepsy association, 13.7% (n=8) of them were PNES with history, clinical, imaging and interictal EEG assessment. Eighteen of the patients (33.3%) who were known as mentally retarded acquired the right to disability. Eighteen of the 36 patients (33.3% of whose mental state was known) who were known not to be mentally retarded obtained the right to pension because they were diagnosed with drug-resistant epilepsy and were using adequate and regular AEDs. Conclusion: Most of the patients referred for hospitalization for the purpose of determining the disability may be given the disability report only with a good history and short-term video EEG monitoring, without hospitalization. In our opinion, this type of practice might be a more economical, practical and valid behavior in terms of time and place. Key words: Epilepsy; disability. ÖzetAmaç: Bu geriye dönük çalışmada, Sosyal Güvenlik Kurumu (SGK) tarafından, kliniğimize sevk edilen epilepsi hastalarının, özürlülük oranlarının saptanması amacıyla en az 15 (ya da 21) gün yatırılarak gözlenmesi ile ilgili Cerrahpaşa Tıp Fakültesi Nöroloji Kliniği'ndeki deneyimi paylaşmak, bu uygulamanın pratikliğini ve geçerliliğini sorgulamayı amaçladık. Gereç ve Yöntem:Çalışmada 2007-2014 yılları arasında İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Nöroloji Kliniği'ne SGK tarafından maluliyet durumunun belirlenmesi amacıyla yatırılmak üzere sevk edilen ve servisimizde yatırılarak izlenen 58 hastanın kayıtları geriye dönük olarak araştırılmıştır. Bulgular: Çalışmaya 58 hasta (10 kadın, 48 erkek) alındı. Dirençli epilepsisi olan hasta sayısı 18 (%33.3) idi. Yatış sırasında 27 olgu tanıklı nöbet geçirdi. Bu hastalardan 11 'inin nöbeti psikojen olarak değerlendirildi. Sekiz olgunun nöbetine tanık olunamadı. Öykü, klinik, görüntüleme ve interiktal EEG değerlendirmeleri ile birlikte hastaların %65.5'i (n=38) epilepsi, %20.6'sı (n=12) nonepileptik psikojen nöbet (NEPN) ve epilepsi birlikteliği, %13.7'si (n=8) ise NEPN tanılarını aldı. Mental retarde olduğu bilinen 18 (%33.3)...

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“…Approximately 30% of patients seen at epilepsy centers for refractory seizures do not have seizures and have been misdiagnosed [1]. As illustrated here, many of them have histories not in the least suggestive of seizures, and have their diagnosis based largely (and sometimes solely) on an 'abnormal' EEG [2][3][4][5][6][7][8].…”

Section: How Serious Is This Problem?mentioning

confidence: 99%

“…to order an EEG than to take a history. The combination of vague, nonspecific symptoms with an equivocal (weak) EEG abnormality is a common cause of inappropriate diagnoses of seizures [4][5][6][7][8]10].…”

Section: Reasons For the Overinterpretation Of Eegsmentioning

confidence: 99%

The tragedy of over-read EEGs and wrong diagnoses of epilepsy

Benbadis¹

2010

Expert Review of Neurotherapeutics

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Preventing misdiagnosis of epilepsy

Cited by 64 publications

References 14 publications

Errors in EEG Interpretation and Misdiagnosis of Epilepsy

Errors in EEG Interpretation and Misdiagnosis of Epilepsy

An approach to epilepsy patients admitted to hospitalization for the purpose of disability determination

The tragedy of over-read EEGs and wrong diagnoses of epilepsy

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