Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

Abstract

Objective: To test the hypothesis that people with focal epilepsy experience diagnostic delays that may be associated with preventable morbidity, particularly when seizures have only nonmotor symptoms, we compared time to diagnosis, injuries, and motor vehicle accidents (MVAs) in people with focal nonmotor versus focal seizures with motor involvement at epilepsy onset. Methods: This retrospective study analyzed the enrollment data from the Human Epilepsy Project, which enrolled participants between 2012 and 2017 across 34 sites in the USA, Canada, Europe, and Australia, within 4 months of treatment for focal epilepsy. A total of 447 participants were grouped by initial seizure semiology (focal nonmotor or focal with motor involvement) to compare time to diagnosis and prediagnostic injuries including MVAs. Results: Demographic characteristics were similar between groups. There were 246 participants (55%) with nonmotor seizures and 201 participants (45%) with motor seizures at epilepsy onset. Median time to diagnosis from first seizure was 10 times longer in patients with nonmotor seizures compared to motor seizures at onset (P < .001). The number and severity of injuries were similar between groups. However, 82.6% of MVAs occurred in patients with undiagnosed nonmotor seizures. Significance: This study identifies reasons for delayed diagnosis and consequences of delay in patients with new onset focal epilepsy, highlighting a treatment gap that is particularly significant in patients who experience nonmotor seizures at epilepsy onset.

Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy

“…18 The remaining 16 studies employed two measures of delay comprising (1) reports of prior seizures and (2) length of time between the first seizure and diagnosis. In the latter group, two 23,28 measured this time period for comparisons between groups, and six studies 4,15,16,19,20,26 utilized a defined period of time between the initial seizure and diagnosis/referral to indicate delay (±prior seizures). This ranged from 1 week to 1 year.…”

“…After the removal of duplicates, a review of abstracts resulted in 54 potentially eligible studies. After assessment of full‐text papers, we found 15 papers that met the criteria for inclusion, plus an additional two earlier papers from our own library (see Tables and ) 2–4,15–28 . One paper was a registry study that used International Classification of Diseases (ICD) codes to identify patients and included individuals who obtained antiepileptic drugs (AEDs) before the epilepsy diagnosis was coded 23 .…”

“…In one study, 4 the concept of disruptive versus nondisruptive seizures was also used; the “disruptive” category captured nonconvulsive seizures that interrupted or disrupted activities in addition to convulsive seizures. Other studies utilized a classification of motor versus nonmotor seizures 22,24,28 . Delay was significantly more likely with nondisruptive or nonmotor seizures.…”

“…Major injuries may not be a common feature given the nonconvulsive nature of most prior seizures, 4,28 although their association with injuries is probably largely missed. Particularly concerning is the risk for activities with little margin for error, such as driving, 4,28,58 swimming, cooking, work with a ladder or heavy machinery, and childcare. Patients who were not prescribed AEDs after a diagnosis of epilepsy were found to have increased injuries (burns, falls, fractures, MVAs) and suicidality compared to those prescribed AEDs, suggesting untreated seizures have some risk of injury.…”

Деякі Практичні Аспекти Призначення Першої Монотерапії Дорослим Пацієнтам Із Епілепсією

“…Тому завжди треба запитувати про будьякі короткочасні феномени, які міг відмічати у себе па цієнт ще до появи судомного нападу (раптові запаморочення, здригання кінцівок, відчуття дежавю або ілюзій, незрозумілого відчуття жару в животі з поширенням на грудну клітку, напади немотивованої агресії або страху (диференціація з панічними атаками), стани, коли пацієнт не може говорити або не розуміє звернену мову, або, за словами свідків, він іноді дивиться в одну точку, ніби «зависає» і не підтримує розмову тощо. На жаль, се редній час встановлення діагнозу епілепсії від першого нападу, за даними J. Pellinen та співавторів (2020) [5], буває у 10 разів дов шим у пацієнтів із немоторними нападами порівняно з рухови ми. Тому тривалий час відсутності лікування може бути одним із чинників подальшої фармакорезистентності.…”