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 HistoryInvestigations

Most important tool in diagnosing epilepsy is… Patient Witness Background History

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! SeizureSyncope TriggerRare (flashing lights)Common (position, venepucture ) ProdromeCommon - auraAlmost invariable Onsetsuddengradual Duration1-2 mins1-30 s JerksCommon, prolongedrare Incontinencecommonuncommon Lateral tongue bite commonrare Post ictal confusion Common, wakes in ambulance Rare, wakes on the floor

seizures Vrs NEA! NEADEpileptic seizures SuggestiblecommonLess common DurationOften prolongedSeconds or minutes Retained consciousness Commonrare Pelvic thrustingcommonrare Erratic movement, fighting commonrare Resisting eye opening commonrare Tongue bitingRare (lip-biting)common Incontinencecommon Post-ictal confusionrarecommon

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  ECG  EEG

Investigations  ECG  EEG  MRI

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