The misdiagnosis of epilepsy: findings of a population study

Scheepers, Bruce; Clough, Peter; Pickles, C.A.

doi:10.1016/s1059-1311(05)80010-x

Cited by 179 publications

(138 citation statements)

References 8 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…In total, 13% of all referrals to a Canadian tertiary adult epilepsy clinic were diagnosed with NCS. This number is consistent with those reported in population studies 14,15 or specialist clinics. 7 Some of our patients carried a diagnosis of epilepsy for over ten years.…”

Section: Discussionsupporting

confidence: 92%

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Josephson

Rahey

Sadler

2007

Can. j. neurol. sci.

View full text Add to dashboard Cite

Neurocardiogenic (vasovagal/vasodepressor) syncope (NCS) is a reflex mediated loss of consciousness resulting from the failure of the autonomic nervous system to maintain adequate cerebral perfusion pressure. 1,2 Excessive peripheral venous pooling of blood in combination with aberrant responses of mechanoreceptors to compensatory cardiac hypercontractility results in a paradoxical reflex bradycardia and drop in peripheral vascular resistance. 3,4 The consequent cerebral hypoperfusion induces a transient loss of consciousness that is associated with abnormal movements (e.g. myoclonic jerks) in 12-90% of patients. 2,[5][6][7][8][9][10] Despite clinical guidelines that distinguish NCS ABSTRACT: Background: Neurocardiogenic syncope (NCS) can be mistaken as a seizure. We reviewed the frequency and diagnostic consequences of this misdiagnosis. Methods: A retrospective review of outpatient adult epilepsy clinic charts (QEII Health Sciences Centre, Halifax, NS) was conducted to identify NCS patients referred with a provisional diagnosis of seizures. Charts were reviewed in detail with an emphasis on the consequences of misdiagnosis. Results: Of 1506 consecutive referrals to the epilepsy clinic, 194 (12.9%) ultimately had a clinical diagnosis of NCS. Mean age was 38 +/-16 years (mean age of syncopal onset was 28 +/-16 years). Two-thirds of referrals were from primary care physicians (including emergency departments) and 18% from neurologists. Thirty-five percent were prescribed antiepileptic drugs (AEDs) prior to referral with eight patients (4.1%) experiencing hypersensitivity reactions. Three of five women had adverse pregnancy outcomes while taking AEDs. One-third of patients had restrictions placed on their driving privileges while 11 patients (5.7%) had their employment interrupted. Diagnostic modalities used in the work-up included EEG (90%), CT head (51%), and MRI head (15%). Conclusions: NCS is commonly misdiagnosed as epilepsy. Some patients had an incorrect diagnosis for > 10 years. Patients with this misdiagnosis are often excessively investigated, inappropriately treated, and have unnecessary restrictions placed on driving and employment. RÉSUMÉ: Syncope neurocardiogénique : fréquence et conséquences d'un diagnostic erroné d'épilepsie.Contexte : Une syncope neurocardiogénique (SNC) peut être prise à tort pour une crise convulsive. Nous revoyons la fréquence et les conséquences d'un tel diagnostic erroné. Méthodes : Nous avons effectué une révision rétrospective des dossiers de patients de la clinique externe d'épilepsie (QEII Health Sciences Centre, Halifax, NS) afin d'identifier les patients ayant présenté une SNC qui y ont été référés avec un diagnostic provisoire de crise convulsive. Les dossiers ont été révisés en détail, particulièrement en ce qui concerne les conséquences d'un diagnostic erroné. Résultats : On a posé ultérieurement un diagnostic de SNC chez 194 (12,9%) de 1506 patients consécutifs référés à la clinique d'épilepsie. L'âge moyen des patients était de 38 ± 16 ans et l'âge moyen au moment ...

show abstract

Section: Discussionsupporting

confidence: 92%

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Josephson

Rahey

Sadler

2007

Can. j. neurol. sci.

View full text Add to dashboard Cite

show abstract

“…While the visible manifestations of epileptic and nonepileptic seizures overlap to a considerable extent, their underlying causes are very different: epileptic seizures are caused by abnormal electrical activity in the brain, while NES are a response to psychological distress and represent a failure of alternative coping mechanisms (Reuber et al 2005). The differentiation of epilepsy and NES disorders is a major challenge: despite technological advances, rates of misdiagnosis remain high -up to 50% in some studies (Howell et al 1989;Scheepers et al 1998;Benbadis et al 2004). This situation is alarming since the most appropriate treatments for epilepsy and NES are very different: most epileptic seizures can be controlled with anti-epileptic drugs, whereas the treatment of choice for NES is psychotherapy (Reuber et al 2005).…”

Section: Listening To People With Seizuresmentioning

confidence: 99%

Metaphors in the description of seizure experiences: Common expressions and differential diagnosis

2011

View full text Add to dashboard Cite

“…However, it is well-known that the rate of misdiagnosis of epilepsy is quite high. 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).…”

Section: Introductionmentioning

confidence: 99%

Diagnoses and referral pattern at a first seizure clinic in London

Palka¹,

Yogarajah²,

Cock³

et al. 2017

Journal of Epileptology

View full text Add to dashboard Cite

SUMMARYBackground. Epilepsy is among the most frequent neurological conditions and it is estimated that approximately 8% of the population experience a seizure at some time in their lives. Aim. To examine the characteristics of patients referred to a First Seizure Clinic (FSC) at a University Hospital in South-West London. Methods. All subjects referred to the FSC at St George's University Hospitals between January and December 2015 were included in this audit. Results. From a total of 257 patients, males 49.5%, age range 16-90, 30% referred by General Practices (GPs), 59.1% by the Accident & Emergency Department (A&E) and 10.9% by other hospital wards, 24.5% did not attend (DNA) the clinical appointment. Females who did not attend were significantly older than males (49.8 years old vs 39.7; p = 0.007). Among those who attended the clinical appointment, 17% were diagnosed first unprovoked seizure, 12.4% acute symptomatic seizure and 28.9% epilepsy. These patients were referred mainly by A&E while GPs referred seizure mimics especially non-epileptic attack disorder (NEAD) and syncope. Patients with NEAD were significantly younger than those with seizures (29.4 years old vs 44.2; p < 0.001) and had a previous psychiatric history (72.7% vs 16.8%; p < 0.001). The proportion of seizure mimics was similar in the older sample group (> 65 years). Regarding acute symptomatic seizures, 33.3% were alcohol-related, 20.8% acute brain insults and 12.5% drug-related (always overdose). Conclusions. 1 in 4 patients referred to a FSC does not attend the clinical appointment, especially older females. More than 1 in 3 cases represent seizure mimics and are referred mainly by GPs.

show abstract

The misdiagnosis of epilepsy: findings of a population study

Cited by 179 publications

References 8 publications

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Metaphors in the description of seizure experiences: Common expressions and differential diagnosis

Diagnoses and referral pattern at a first seizure clinic in London

Contact Info

Product

Resources

About