diagnosis and misdiagnosis. diagnosing epilepsy can be difficult! just because somebody shakes and...
TRANSCRIPT
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
History Investigations
Most important tool in diagnosing epilepsy is…
Patient
Witness
Background
HistoryHistoryHistory
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!
Seizure Syncope
Trigger Rare (flashing lights) Common (position, venepucture )
Prodrome Common - aura Almost invariable
Onset sudden gradual
Duration 1-2 mins 1-30 s
Jerks Common, prolonged rare
Incontinence common uncommon
Lateral tongue bite
common rare
Post ictal confusion
Common, wakes in ambulance
Rare, wakes on the floor
seizures Vrs NEA!
NEAD Epileptic seizures
Suggestible common Less common
Duration Often prolonged Seconds or minutes
Retained consciousness
Common rare
Pelvic thrusting common rare
Erratic movement, fighting
common rare
Resisting eye opening
common rare
Tongue biting Rare (lip-biting) common
Incontinence common common
Post-ictal confusion rare common
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
ECGEEG
Investigations
ECGEEGMRI
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