This copy of the annotated bibliography only has one difference from the previous one. This copy contains a new article, the article by Fattouch et al., because in the last bibliography, my first article was a systematic review and not original research. No other changes were made to this revised version. It was easier to write the paragraphs for this article because I had already gotten some practice from writing the bibliography for the other articles.
Misdiagnosis of Epilepsy: An Annotated Bibliography
Fattouch J., Di Bonaventura C., Strano S., Vanacore N., Manfredi M., Prencipe M., Giallonardo A.T. 2007. Over-interpretation of electroclinical and neuroimaging findings in syncope misdiagnosed as epileptic seizures. Epileptic Discord. 9(2)(170-173) [Internet][Accessed May 8 2019] Available from: https://pdfs.semanticscholar.org/d2f5/2e5e508d5cb5fbae52f1d0256a4759220345.pdf
This article dealt with a study aimed at delving into the different factors which impact misdiagnosis revolving epilepsy. In this study, the history, clinical data, and EEG/neuroimaging test results, of 62 patients, were assessed to come up with a diagnosis. 57 of these patients were found to have a definite diagnosis of syncope. They were divided up into two groups to further analyze their data accordingly. 30 of the patients had been on anti-epileptic drugs (AEDs) because they had received a “definite epileptic” diagnosis; they made up the syncopes misdiagnosed as epileptic seizures (SMS) group. 27 of the patients were not on AEDs because they were only suspected of having epilepsy; these individuals were labeled as unrecognized syncopes (US). There was a questionnaire completed, and EEGs and MRIs taken, to aide in the epilepsy vs syncope diagnosis. There were differing results of epileptic risk factors found in both the SMS and US individuals, detected by the questionnaire. 21 out of the 30 SMS patients showed abnormal EEGs and 11 out of 30 showed some alteration in their MRI findings. In the US group, 9 out of 27 had EEG abnormality and only 1 had an MRI alteration. These results led to the article’s conclusion that centers that do not specialize in epilepsy will have a harder time in properly diagnosing epilepsy and syncope because of the misinterpretation of clinical, EEG, and neuroimaging results. The questionnaire used in this study was proposed as an additional tool in differentiating between epilepsy and syncope. However, syncope related features and epileptic features can coexist, and syncope EEGs very often contain abnormalities which can point to epilepsy. Therefore, it is essential that all data and clinical history is carefully considered before a diagnosis is made. Furthermore, any cases which present with a mix of both signs, should be automatically referred to an epilepsy specialized center before a diagnosis is made. This article will be used in the lit review to show the misinterpretation of EEGs and other data results which can lead to mistaking syncope as epilepsy. This article can also serve as a suggestion for how to minimize future misdiagnosis- by referring patients to epilepsy centers before a diagnosis is given.
The credibility of this source was established through the qualifying expertise and ranging skills of the authors. The two leading authors, Fattouch and Di Bonaventura, are from the Epilepsy Unit in the Department of Neurological Sciences, which gives them the reliability to speak on the topic of epilepsy. The other authors specialized in areas such as Cardiovascular pathophysiology, Epidemiology, Surveillance and Health Promotion in the NIH, and Neuromedicine in the Neuromed Institute of Pozzilli, which gives a wide range of areas needed for this study specifically. Additionally, the study was performed on patients collected and observed over a thee year period, which gives the study more precision. However, there were only 57 patients, which makes for a small sample size.
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. The 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 not 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: http://www.neurologyindia.com/article.asp?issn=0028-3886;year=1999;volume=47;issue=3;spage=210;epage=3;aulast=murthy
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.
