Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies

Xu, Ying; Nguyen, Dennis C.; Mohamed, Armin; Carcel, Cheryl; Li, Qiang; Kutlubaev, Mansur A.; Anderson, Craig S.; Hackett, Maree L.

doi:10.1016/j.seizure.2016.08.005

Cited by 97 publications

(69 citation statements)

References 53 publications

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“…However, it is clear that the stage of development remains critical, as illustrated by a study realized in a CAE rat model in which an early treatment can definitively suppress the epileptic activity. This finding has obvious implications for clinical practice, since it is well known that the rate of epilepsy misdiagnosis is high, confounding between real epileptic syndromes and nonepileptic seizures . In addition, this finding highlights the necessity to investigate the clinical effect of new AEDs when used as a first‐line treatment.…”

Section: Discussionmentioning

confidence: 91%

Long‐term negative impact of an inappropriate first antiepileptic medication on the efficacy of a second antiepileptic medication in mice

et al. 2018

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Childhood absence epilepsy (CAE) is one of the most frequent epilepsies in infancy. The first-line recommended therapy for CAE is based on the prescription of the narrow-spectrum ethosuximide and the broad-spectrum valproic acid, which have similar efficacy in the first 12 months. Nevertheless, some antiepileptic drugs (AEDs) may worsen seizure duration and type in this syndrome. In line with this, we have encountered a case of identical twins with CAE and early exposure to different antiseizure drugs leading to divergent outcomes. From this, we hypothesized that the first AED to treat CAE may determine the long-term prognosis, especially in the developing brain, and that some situations leading to drug resistance may be explained by use of an inappropriate first AED. Therefore, we investigated this hypothesis by using a genetic mouse model of absence epilepsy (BS/Orl). Mice received a first appropriate or inappropriate AED followed by the same appropriate AED. Our data demonstrate that an inappropriate first AED has a negative impact on the long-term efficacy of a second appropriate AED. This work supports the necessity to effectively diagnose epileptic syndromes prior to medication use, particularly in children, in order to prevent the deleterious effects of an inappropriate initial AED.

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Section: Discussionmentioning

confidence: 91%

Long‐term negative impact of an inappropriate first antiepileptic medication on the efficacy of a second antiepileptic medication in mice

et al. 2018

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“…National Institute for Health and Care Excellence guidelines recommend that all children and young people who have had a first non‐febrile seizure should be seen as soon as possible by a specialist in management of the epilepsies to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs. Misdiagnoses of events in NOSC have previously been shown to be higher (19.3%) with a non‐specialist clinician compared to a neurologist (5.6%). The consequence of a misdiagnosis may result in unnecessary treatment with AED in up to 30% of patients .…”

Section: Discussionmentioning

confidence: 99%

“…Misdiagnoses of events in NOSC have previously been shown to be higher (19.3%) with a non‐specialist clinician compared to a neurologist (5.6%). The consequence of a misdiagnosis may result in unnecessary treatment with AED in up to 30% of patients . It may limit future employment opportunities and result in unnecessary restriction of life‐style.…”

Section: Discussionmentioning

confidence: 99%

Paediatric new‐onset seizure clinic in Australia: Experience and lessons learnt

Shah

Nagarajan

Palumbo

et al. 2018

J Paediatrics Child Health

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Aim A new‐onset seizure clinic (NOSC) was established at our hospital in 2011, with the aim to provide accurate diagnosis and appropriate management to children with new‐onset seizures or seizure mimics. Methods We report on the data analysis of the first 200 children seen in NOSC. A paediatric neurologist or paediatric/neurology trainee under supervision of a neurologist reviewed all the children. A detailed history and clinical examination were undertaken. Electroencephalogram (EEGs) were undertaken prior to clinic review in most emergency departments. Children were classified as ‘epilepsy positive’ (EP+) or ‘epilepsy negative’ (EP−) after the first consultation. Results Of 200 patients, 109 were classified as EP+: generalised epilepsy in 57 of 109, focal in 36, childhood seizure susceptibility syndrome in 26 and epileptic encephalopathy in 5. EEG was available in 192: in 117, it was abnormal – 23 with background abnormalities and 109 with epileptiform activity. Of the 109 patients, 80 were commenced on anti‐epileptic drugs (AEDs): 12 were able to come off medication after seizure‐free period, 61 were controlled on AEDs and 7 were refractory. Children were followed up for 12–48 months. None of the children had diagnosis revised on follow‐up. Conclusions This is the first Australian study to report on a large cohort of children from a NOSC. An EEG and a paediatric neurologist assessment is a good combination to enable diagnostic accuracy: In the first 200 patients seen, there were no revisions of the initial diagnosis on follow‐up.

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“…The accurate diagnosis of epilepsy relies on a thorough and expert clinical history and its corroboration by a witness description4 and may be challenging; with a misdiagnosis rate of 2%–71% 5. A seizure is an observable abrupt paroxysmal change in behaviour or consciousness and can occur due to various causes, including epileptic, syncope and functional 6.…”

Section: The Diagnosis Of Epilepsymentioning

confidence: 99%

Fifteen-minute consultation: When medicines don’t work—the child with poorly controlled seizures

Harijan

Seal

Prasad

et al. 2018

Arch Dis Child Educ Pract Ed

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Drug-resistant epilepsy (DRE) occurs in 20%–30% of children with epilepsy with significant impact on their quality of life. Management of this group of children has greatly improved in the recent years with streamlining of epilepsy surgery services and associated quaternary multimodal evaluation. This article provides a review of DRE in children and management based on recent evidence and published opinion. We have also presented an algorithmic approach to the child with possible DRE.

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Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies

Cited by 97 publications

References 53 publications

Long‐term negative impact of an inappropriate first antiepileptic medication on the efficacy of a second antiepileptic medication in mice

Long‐term negative impact of an inappropriate first antiepileptic medication on the efficacy of a second antiepileptic medication in mice

Paediatric new‐onset seizure clinic in Australia: Experience and lessons learnt

Fifteen-minute consultation: When medicines don’t work—the child with poorly controlled seizures

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