This final copy of my annotated bibliography had a source which was not original research, but a systematic review, for that reason it is labeled the original. However, it is not the final copy which I received a grade for in class. This annotated bibliography was effective in summarizing the important parts of the article and listing what their functions would be in the literature review. The part I struggled with most for this assignment was the credibility of the article, I had to search for some outside sources to find the credentials of the authors. For most of the authors however I couldn’t find much information.
Misdiagnosis of Epilepsy: An Annotated Bibliography
Chapman M., Iddon P., Atkinson K., Brodie C., Mitchell D., Parvin G., and Willis S. 2011. The misdiagnosis of epilepsy in intellectual disabilities: a systematic review. Seizure. 20(2)(101-106) [Internet][Accessed April 10 2019] Available from: https://www.sciencedirect.com/science/article/pii/S105913111000261X
This article addresses the concept of misdiagnosis involving epilepsy, especially in patients with intellectual disabilities, a population in which epilepsy can be very common. The questions this study aimed to answer were: how common the misdiagnosis of epilepsy in individuals with intellectual disabilities was, what were the reasons for the misdiagnosis, what were the implications of the misdiagnosis, and how can future diagnostics be improved. One of the main points made in this article refers to the negative implications that can befall a patient once misdiagnosed with epilepsy. The implications stated were distress to both the patient and those taking care of them, any social stigmatization surrounding epileptic people, financial deprivation, and unnecessary treatment. 48% of patients with Rett Syndrome had seizures that were not associated with EEG epileptic seizures but were still receiving antiepileptic medication. On the flipside, patients in need of epileptic treatment might not receive it because they have not been properly diagnosed- 30% of women with Rett Syndrome were in need of antiepileptic medication but were not receiving it. A large part of misdiagnosis was said, in this article, to come from the inability of parents, caregivers, and/or health professionals to accurately interpret signs as being epileptic or non-epileptic events. The results showed that about 82% of parents incorrectly reported an epileptic episode in their daughters with Rett Syndrome. Whereas there were 13 individuals with Rett Syndrome who actually had epileptic symptoms based on their EEGs, but only 5 of those 13 parents were able to identify the episode as an epileptic one. Poor training on the part of health care professionals can often lead to a misdiagnosis of epilepsy. Along with poor training there might have been cases of poor communication and inconsistency in checking on the patient. It was stated that these factors leading to misdiagnosis can be most prominent when dealing with rare disability syndromes, because these symptoms aren’t often very known and can be mistaken for epileptic events. An EEG is one tool used for the diagnosis of epilepsy, however, in the conclusion it is stated that an EEG was not always used. When used it was not determined if the length of time designated for the EEG was enough to detect epileptic seizures. Another very strong point was made in the conclusion of this article, stating that when a patient is referred for monitoring, there is some type of doubt associated with their initial diagnosis and uncertainty with what the right diagnostic would be. Therefore, it makes sense for there to be an overestimation to then be referred for monitoring. This article will be useful for the literature review to present data and important points referring to what a misdiagnosis can cause in patients as well as some pressing factors which might lead to a misdiagnosis or overestimated diagnosis.
An evaluation of the credibility of this article pointed towards it being a credible source due to the diversity of skills and knowledge of its authors. Also, the different databases were reviewed by at least two different authors to ensure there was no bias or misinterpretation occurring. Melanie J Chapman is a Faculty of Health, Psychology, and Social Care at Manchester Metropolitan University with a specialty in intellectual disabilities. This shows that she is very qualified to speak on the issue of misdiagnosis and treatment of those with intellectual disabilities.
Hindley D., Ali A., Robson C. 2006. Diagnoses made in a secondary care “fits, faints, and funny turns” clinic. ADC. 91(3)(214-218). [Internet] [Accessed April 15 2019]Available from: https://adc-bmj-com.clinical-proxy.libr.ccny.cuny.edu/content/91/3/214
This article deals with 380 children referred to a secondary clinic from different sources- pediatricians, psychiatrists, pediatric neurologists- with an epilepsy diagnosis over an eight-year period (1995-2003). The children referred to these clinics were either first timers, showing symptoms for the first time, or those that already had an epileptic diagnosis and needed further specification for management. The diagnoses were made based on family history, any previous clinical information, and the witnessed accounts of parents and family-members (these were preferably taped, which allowed for interpretation of the doctor instead of from the parents who had no idea what they were witnessing). The results showed that 23% (89 children) were newly diagnosed with epilepsy, 26% (100 children) were diagnosed with syncope, 36% (138 children) were diagnosed with other non-epileptic events, and 14% (53 children) were labeled as unclassified events. In those diagnosed with non-epileptic events, different paroxysmal events were present, among which identified were syncope, psychological episodes, daydreams, night terrors, migraines, benign paroxysmal vertigo, ritualistic movements, and exaggerated parental anxiety or fabricated illness. All of these are very common in infancy and childhood and can often be confused with epilepsy. For example, frequent daydreams can be referred to an epileptic specialist out of fear that a child might be experiencing something known as childhood absence epilepsy. The commonalities between the non-epileptic and epileptic symptoms can often cause the misdiagnosis of epilepsy by viewing any unusual mannerisms and behaviors. This article will be used in the literature review as a source of different non-epileptic diagnostics available that present similar to epileptic symptoms and contribute to the common misdiagnosis of epilepsy.
When establishing the credibility of this article, the time span across which it takes place was considered. The fact that the data was collected over a time span of eight years gives it an aspect of accuracy because it had a relatively large sample size and varying time stamps. An aspect which gives the experiment itself credibility is the fact that the same clinician saw all of the children used in this study. This adds a layer of credibility because there is no discrepancy or area for opposing views because it was all performed by one doctor. All three authors of this article are associated with Fairfield General Hospital and the University of Manchester. Dr. D Hindley is a consultant Pediatrician at Halliwell Children’s Center which contributes to their credibility to speak about children and their behaviors which could be confused with epileptic symptoms.
Murthy JM. 1999. Factors of error involved in the diagnosis of juvenile myoclonic epilepsy: a study from South India. Neurology India. 47(3)(210-213). [ Internet] [Accessed April 13 2019] Available from: http://www.neurologyindia.com/article.asp?issn=0028-3886;year=1999;volume=47;issue=3;spage=210;epage=3;aulast=murthy
This article discusses the misdiagnosis of epilepsy, specifically of Juvenile Myoclonic Epilpesy, in a developing country- South India. It has a focus on the time stamp of diagnosis rather than the incorrect labeling of epilepsy. Murthy aimed to find some possible reasons as to why Juvenile Myoclonic Epilepsy (JME) is so often underdiagnosed or diagnosed very late after rise of first symptoms. 131 patients were studied, 90% of those patients were immediately diagnosed at the time of registration at the clinic and 10% were diagnosed during a follow-up. Th article lists the median age of onset as 13.37 + 4.83 years old, and that it took 6.8 + 6.3 years from the onset of the disease for it to be diagnosed properly. In 20 of the patients (15%), it took more than 10 years for diagnosis. Murthy mentions that major factors of delay in diagnosis were the failure to ask about or properly interpret the history of the presence of myoclonic jerks and the lack of knowledge regarding the symptoms of this specific epileptic syndrome. Another factor is that patients might go to the clinic looking for treatment of a specific type of seizure which causes a delay in doctors properly diagnosing the presence of JME. For example, 9 patients had an initial diagnosis of absence epilepsy and the seizures they were seeking treatment for were absences, however their EEGs showed wave activity in conjunction with JME criteria. Additionally, there is the possibility to recognize one of the JME criteria symptoms but not another, making it harder to fully diagnose JME. For example, generalized tonic clonic seizures (GTCS) are often the first symptoms to appear but the circadian relations to awakening from sleep might be fully manifested right away, two symptoms which are complementary of JME. One important thing pointed out in this article is that some criteria of JME might make an appearance years in advance before another, such as the appearance of absence seizures can precede GTCS and myoclonic jerks by 4 to 5 years. Once the myoclonic jerks and GTCS are present is when the official diagnosis of JME can be established. Meaning that some patients might receive an preliminary childhood or juvenile absence epilepsy before it progresses to a JME diagnosis. This article will pose as record of factors which can both attribute to misdiagnosis as well as delay in diagnosis of epilepsy, specifically of JME. It can also serve as a basis for why constant follow-ups are important, especially when an initial epilepsy diagnosis is given.
Dr. J M Murthy is a Neurologist in hospital care in India. Her areas of specialty are neuro electrophysiology, movement disorders, neuro muscular disorders, tumors, spine and spinal disorders, migraines, strokes, and epilepsy. This attests to her ability to discuss matters concerning epilepsy diagnosis, EEG readings, and care in India.
Uldall P., Alving J., Hansen L K., Kibaek M., Buchholt J. 2006. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events. ADC. 91(3)(219-221). [Internet] [Accessed April 10 2019] Available from: https://adc-bmj-com.clinical-proxy.libr.ccny.cuny.edu/content/91/3/219
The purpose of this article was to figure out what portion of children admitted to an epileptic center did not actually have epilepsy. In this article, there was an extensive review of case notes regarding 223 children admitted to an epilepsy center. It establishes that a good description from parents and EEG’s from a medical setting is needed to accurately collect data needed for an epileptic diagnosis. 39% of the children (87 out of the 223) were found to not have epilepsy. From the 223 children, 39 of them (17%) had referrals where their doctor had doubt about their epileptic diagnosis. From these 39 uncertain referrals, 18% had confirmed epilepsy and 82% did not have confirmed epilepsy. 184 children (83%) had referrals where their doctors were “without a doubt” certain of their epileptic diagnosis. From these, 70% had a confirmed epileptic diagnosis and 30% did not actually have epilepsy. The article states that getting a good reading on an EEG is very difficult in clinical setting that are not specialized in epilepsy. Regardless, the majority of doctors who are referring children to the tertiary epilepsy seem to be certain in their diagnosis. The referrals are often given at the request of parents and not because the pediatrician sees it fit. For doctors who are, nearly a hundred percent, without a doubt, sure that their patients have epilepsy to have a 30% incidence of that epileptic diagnosis disproven is a rather large risk they are willing to take by not referring patients without the request of parents. This article shows that even when a doctor is very sure of their diagnosis, there is still room for error. This article is being used to show data for the misdiagnosis of epilepsy even when doctors are sure in their diagnosis.
Dr. P Uldall is a neuropediatric doctor at the Danish Epilepsy Center, giving him credibility to discuss this topic in detail. J Alving is a senior consultant specializing in the area of EEG and epilepsy monitoring unit, which gives him the ability to speak about the process of and the faults in using EEGs to diagnose epilepsy.
