This paper was presented in condensed form at the Annual Course of the American Epilepsy Society at Washington DC on the 4th of December 2005 by C. A. van Donselaar.
How Confident Are We of the Diagnosis of Epilepsy?
Article first published online: 11 OCT 2006
Volume 47, Issue Supplement s1, pages 9–13, October 2006
How to Cite
Van Donselaar, C. A., Stroink, H., Arts, W.-F. and for the Dutch Study Group of Epilepsy in Childhood (2006), How Confident Are We of the Diagnosis of Epilepsy?. Epilepsia, 47: 9–13. doi: 10.1111/j.1528-1167.2006.00653.x
The Dutch Study Group of Epilepsy in Childhood (DSEC) consists besides the authors, of O. F. Brouwer (University Medical Centre Groningen), A. C. B. Peters and O. van Nieuwenhuizen (University Medical Centre Utrecht), E. Peeters (Medical Centre Haaglanden, the Hague), and A. T. Geerts (Erasmus Medical Centre, Rotterdam). The DSEC received several grants from the Dutch National Epilepsy Foundation.
Conflict of interests: none.
- Issue published online: 11 OCT 2006
- Article first published online: 11 OCT 2006
- First seizure;
- Interobserver reliability;
- Interobserver agreement;
Summary: The diagnosis of a first seizure or epilepsy may be subject to interobserver variation and inaccuracy with possibly far-reaching consequences for the patients involved. We reviewed the current literature.
Studies on the interobserver variation of the diagnosis of a first seizure show that such a diagnosis is subject to considerable interobserver disagreement. Interpretation of the electroencephalogram (EEG) findings is also subject to interobserver disagreement and is influenced by the threshold of the reader to classify EEG findings as epileptiform. The accuracy of the diagnosis of epilepsy varies from a misdiagnosis rate of 5% in a prospective childhood epilepsy study in which the diagnosis was made by a panel of three experienced pediatric neurologists to at least 23% in a British population-based study, and may be even higher in everyday practice. The level of experience of the treating physician plays an important role. The EEG may be helpful but one should be reluctant to make a diagnosis of epilepsy mainly on the EEG findings without a reasonable clinical suspicion based on the history.
Being aware of the possible interobserver variation and inaccuracy, adopting a systematic approach to the diagnostic process, and timely referral to specialized care may be helpful to prevent the misdiagnosis of epilepsy.