Preventing misdiagnosis of epilepsy

Commentary on the papers by Hindley et al (see page214) and Uldall et al (see page219) It has become axiomatic that the rate of misdiagnosis of epilepsy is high. A population based study mainly in adults found a misdiagnosis rate of 23%,1 while 26% of subjects referred to a single adult neurologist with “refractory epilepsy” were found not to have epilepsy.2 Hitherto, hard data in children on this has been lacking. Two studies in this month’s Archives address aspects of this from different perspectives. Hindley et al report an eight year prospective study of the diagnoses made in children referred to a secondary level “fits, faints, and funny turns” clinic in Bury, UK.3 Uldall et al report a retrospective study of the final diagnosis compared to the referral diagnosis of 223 children admitted during 1997 to the Danish Epilepsy Centre which takes referrals from the whole of Denmark.4 Hindley et al found that epilepsy was the diagnosis in only 23% of the children referred.3 The largest diagnostic group was syncope of various sorts (42%). Other relatively common diagnoses were psychological non-epileptic events (8%), daydreaming (5%), night terrors (4%), migraine (3%), benign paroxysmal vertigo (2%), ritualistic movements, including gratification (2%), and parental anxiety/fabricated illness (2%). A miscellany of other conditions, including paroxysmal movement disorders, accounted for 8% of diagnoses. Fourteen per cent of patients remained undiagnosed. Unfortunately, the paper does not give referral diagnoses. It would be disingenuous to suggest that epilepsy was the preferred (or even likely) referral diagnosis in all. However, it is probable that it was suspected in many of those subsequently found not to have epilepsy. Uldall et al found that 39% of those referred to the Danish Epilepsy Centre did not have epilepsy.4 In 17% of referrals …