Diagnosis after a first paroxysmal event may be difficult; even experienced clinicians may disagree. In the Netherlands (Journal of Neurology, Neurosurgery, and Psychiatry2004;75:241–5OpenUrlAbstract/FREE Full Text) six experienced paediatric neurologists (two panels of three each) were presented with detailed descriptions of 100 first paroxysmal events in children. Using clinical judgement the individual paediatric neurologists reached only 41% agreement about seizure diagnosis (kappa (degree of agreement beyond chance) = 0.41). When they used defined criteria the degree of agreement was 45%. The two panels were able to reach 60% agreement after discussion within each panel. For seizure classification agreement between individuals was 46% using clinical judgement and 57% using defined criteria. Agreement between panels was 69%. The panels could agree on syndrome diagnosis for only 24 of 51 children considered to have had a first seizure.

Congenital leukaemia is rare, not always fatal, and to be distinguished from transient myeloproliferative disorder (TMD). In the Northern Health Region of England during an 18-year period (October 1984–September 2002) nine infants were referred to the central unit with a diagnosis of possible acute leukaemia arising before the age of 3 months (Journal of Clinical Pathology2004;57:186–8)OpenUrlAbstract/FREE Full Text. Five had acute leukaemia and four TMD. Of the four infants with TMD three had Down’s syndrome and the fourth had trisomy 21 in proliferating marrow cells. The …