Diagnosis and Misdiagnosis

Diagnosing epilepsy can be difficult!

• Just because somebody shakes and wets does not mean they are having a seizure

Heath M. The Spectator cartoon book 2000: St Edmundsbury Press Ltd, London

And just because somebody is having a seizure does not mean they have epilepsy…

Epilepsy is a clinical diagnosis

Patient

History Investigations

Most important tool in diagnosing epilepsy is…

Patient

Witness

Background

HistoryHistoryHistory

First eliminate the usual suspects

• Syncope• NEAD• Hypoglycaemia• Hyperventilation • Panic Attacks• Episodic dyscontrol

syndrome

• Breath-holding attacks • Movement disorders• Migraine• Day dreaming• TIA’s• Vertigo

seizures Vrs syncope's!

Seizure Syncope

Trigger Rare (flashing lights) Common (position, venepucture )

Prodrome Common - aura Almost invariable

Onset sudden gradual

Duration 1-2 mins 1-30 s

Jerks Common, prolonged rare

Incontinence common uncommon

Lateral tongue bite

common rare

Post ictal confusion

Common, wakes in ambulance

Rare, wakes on the floor

seizures Vrs NEA!

NEAD Epileptic seizures

Suggestible common Less common

Duration Often prolonged Seconds or minutes

Retained consciousness

Common rare

Pelvic thrusting common rare

Erratic movement, fighting

common rare

Resisting eye opening

common rare

Tongue biting Rare (lip-biting) common

Incontinence common common

Post-ictal confusion rare common

Epilepsy or Not?

common causes of seizures

→head injury→brain infection

→lesions→drug Alcohol abuse

→pre-eclampsia→hypoglycaemia

→pyrexia →brain tumour

→lifestyle

Investigations

ECG

Investigations

ECGEEG

Investigations

ECGEEGMRI

Misdiagnosis in epilepsy is common

estimated around 25%

In 2002 estimated that 92,000 people were misdiagnosed in the UK costing the NHS £29,000,000