Causes of overdiagnosis of epilepsy in children

Abstract

Misdiagnosis of epilepsy is a common phenomenon (up to 20% of the total population of patients with epilepsy and up to 30–40% in the population of pharmacoresistant epilepsy) and dangerous, leads to significant social restrictions and is accompanied by significant unjustified medical expenses. The objective reasons for misdiagnosis include a large number (about 40) of conditions that are similar and often indistinguishable in their clinical manifestations from epileptic seizures, descriptive character and lack of obligatory diagnostic criteries (especially electroencephalographic), limiting medical access to the necessary research methods. The subjective errors include insufficiently collecting anamnesis, exaggerating the possibility of developing a more rare disease (in this case epilepsy), a false impression of the doctor that if epilepsy is not diagnosed, then it will have the most terrible consequences. The situation of misdiagnosis is aggravated by the fact that neurophysiologists are more likely to overestimate the EEG in the direction of epileptic and epileptiform (interictal) phenomena. Subjective errors are eliminated by learning and self-learning. Even the most experienced epileptologists can make mistakes with the diagnosis, and in a certain sense mistakes are inevitable. We can’t always wait for the final diagnosis and often have to start treatment without being 100% sure of the diagnosis of epilepsy. Therefore, it is necessary to practice the periodic revision of the diagnosis of epilepsy, especially in cases where the disease is difficult to treat.