PT  - JOURNAL ARTICLE
AU  - P Uldall
AU  - J Alving
AU  - L K Hansen
AU  - M Kibæk
AU  - J Buchholt
TI  - The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events
AID  - 10.1136/adc.2004.064477
DP  - 2006 Mar 01
TA  - Archives of Disease in Childhood
PG  - 219--221
VI  - 91
IP  - 3
4099  - http://adc.bmj.com/content/91/3/219.short
4100  - http://adc.bmj.com/content/91/3/219.full
SO  - Arch Dis Child2006 Mar 01; 91
AB  - 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.