EditorialErrors in EEGs and the misdiagnosis of epilepsy: Importance, causes, consequences, and proposed remedies
Section snippets
Importance and frequency
The misdiagnosis of epilepsy has been brought to the forefront and the lay public in the United Kingdom because of a high-profile legal case about the misdiagnosis of epilepsy by a pediatric neurologist [1], [2]. Because roughly 30% of his patients treated for epilepsy were found not to have it, the scapegoat, Dr. Andrew Holton, was suspended in 2001. A £10 million compensation (for parents and children) was approved by a High Court judge in 2005. He appealed in March 2006 and lost the appeal
Consequences
J.J. is a 25-year-old man whose lifelong dream was to join the Air Force. Unfortunately, while in training, J.J. had a single suspicious episode of loss of consciousness after a night of partying, sleep deprivation, alcohol use, and ingestion of body building supplements. The episode was unwitnessed and equally compatible with a seizure or syncope. Even if it was a seizure, it was arguably provoked. He was dismissed from the Air Force because of an abnormal EEG. He was not dismissed because of
Reasons and causes
The diagnosis of seizures relies heavily on a good history, the elicitation of which requires skills and time. In the modern area of busy practices and reimbursement pressures, doctors and patients alike tend to have more faith in “tests.” And the test in question here is the EEG.
Routine EEGs are frequently misused and misread, and contribute to the common problem of epilepsy misdiagnosis. The specificity of electroencephalography for epilepsy, unlike its sensitivity, is very high. Only 1–2% of
Possible solutions and recommendations
On the basis of the preceding discussion of the mechanisms that lead to overreading and misdiagnosis, the following should be considered.
Clearly many neurologists who read EEGs are not adequately trained to do so. The reality is that most EEGs ordered in routine clinical practice (typically for encephalopathy) have little or no impact on diagnosis, management, and outcome. In fact, many EEGs, as is true of all medical tests, are probably ordered for nonmedical reasons (e.g., economic and
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Cited by (92)
Ambulatory video EEG extended to 10 days: A retrospective review of a large database of ictal events
2023, Clinical NeurophysiologyA quantitative approach to evaluating interictal epileptiform discharges based on interpretable quantitative criteria
2023, Clinical NeurophysiologyCitation Excerpt :Correctly classifying sharp transients on EEG as epileptiform or non-epileptiform carries high weight in the clinical decision-making process in many scenarios (Fisher et al., 2014). Both over- and under-calling interictal epileptiform discharges (IEDs) can lead to epilepsy misdiagnosis and resultant harm to patients and healthcare systems (Benbadis, 2007). Notably, EEG misinterpretation is an issue not only when EEGs are read by neurologists without EEG training (Amin and Benbadis, 2019) – a common practice in the US (Adornato et al., 2011) – but also when studies are read by experts.
Impact of ambulatory EEG in the management of patients with epilepsy in resource-limited Latin American populations
2023, Clinical Neurophysiology PracticeNeurology resident EEG training in Europe
2022, Clinical Neurophysiology PracticeEEG normal variants: A prospective study using the SCORE system
2022, Clinical Neurophysiology PracticeCitation Excerpt :Sharp transients (Fig. 1) are sharp EEG changes/fluctuations of the background activity which do not fulfill the operational criteria for epileptic discharges defined by the IFCN (Kane et al., 2017; Kural et al., 2020). These fluctuations in the EEG background activity have a sharp morphology and a higher amplitude and can easily be misinterpreted as epileptic discharges (Benbadis, 2007; Benbadis and Lin, 2008; Benbadis and Tatum, 2003). In this study, sharp transients were the most often described normal variant with 19.25%.