Elsevier

Epilepsy & Behavior

Volume 11, Issue 3, November 2007, Pages 257-262
Epilepsy & Behavior

Editorial
Errors in EEGs and the misdiagnosis of epilepsy: Importance, causes, consequences, and proposed remedies

https://doi.org/10.1016/j.yebeh.2007.05.013Get rights and content

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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