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The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events
  1. P Uldall,
  2. J Alving,
  3. L K Hansen,
  4. M Kibæk,
  5. J Buchholt
  1. Danish Epilepsy Centre, Kolonivej 1, DK-4293 Dianalund, Denmark
  1. Correspondence to:
    Dr P Uldall
    Rigshospitalet, Neuropaediatric Clinic 5003, DK-2100 Copenhagen Ø, Denmark; pu{at}rh.dk

Abstract

Aims: To determine the proportion of children admitted with difficult to treat paroxysmal events to a tertiary epilepsy centre who did not have epilepsy.

Methods: In an observational retrospective study, all case notes of 223 children admitted in 1997 were examined. The referral was made from the local paediatric department in 51% of cases, other departments in 27%, and from general or specialist practitioners in 22%. Doubt regarding the diagnosis of epilepsy was expressed in the referral note in 17%. On admission, 86% were on antiepileptic drug treatment. During admission all children were subjected to a comprehensive intensive observation and 62% had EEG monitoring.

Results: In total, 39% (87/223) were found not to have epilepsy. In 30% of children (55/184) referred without any doubts about the epilepsy diagnosis, the diagnosis was disproved. Of the 159 children admitted for the first time, 75 (47%) were discharged with a diagnosis of non-epileptic seizures. Of 125 children admitted for the first time with no doubts about the diagnosis of epilepsy, 44 (35%) did not have epilepsy. Staring episodes were the most frequently encountered non-epileptic paroxysmal event. Psychogenic non-epileptic seizures were found in 12 children. A total of 34 (15%) had their medication tapered off; a further 22 (10%) had tapered off medication before admission.

Conclusion: The present study supports the view that misdiagnosis of epilepsy is common. The treating physician should be cautious in diagnosis, especially of staring episodes. A diagnostic re-evaluation should be undertaken in difficult cases with continuing paroxysmal events in order to avoid unnecessary drug treatment and restrictions on the child’s lifestyle.

  • AED, antiepileptic drug
  • EEG, electroencephalogram
  • PNES, psychogenic non-epileptic seizures
  • misdiagnosis
  • non-epileptic events
  • re-evaluation
  • specialised epilepsy centres
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Footnotes

  • Competing interests: none declared

  • The co-author Jette Buchholt has passed away since this paper was accepted.

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