Abstracts

RATIONALE: Misdiagnosis and late diagnosis of epilepsy are one of the factors of bad therapeutic prognosis. Therefore we studied the diagnostic state of epilepsy patients on admission to our epilepsy center. METHODS: Included in this study were patients over 16 years of age. Patients who were already inpatient before admitted to the epilepsy unit were excluded. From 654 continiously admitted epilepsy patients, 253 fullfilled the criteria. Written information (case reports) were analysed. RESULTS: 2/3 of the patients were admitted by neurologists, 1/3 by general practitioners. Seizure diagnosis: Only 60 % of none-epileptic psychogenic seizures were analysed. 2/3 of the cases with complex focal seizures were correctly diagnosed. But auras were analysed only in 1/3 of the cases. The same was true for the absences which were diagnosed only in 33 %. Epileptic syndroms: The differentiation between single event related seizure and epilepsy was made correctly only in 50 %. The differentiation between focal and generalised epilepsy was made only in 40%. The classification of generalised idiopathic epilepsies was correct only in 36 %. The classification of temporal epilepsy was made in 42 % but this diagnosis was verified only in 64 % by the analysis of the epilepsy center. CONCLUSIONS: The analysis shows that both seizure diagnosis and syndrom classification from none-specialised doctors is poor and could be improved. The judgment of a severe epilepsy or therapeutic resistance in many cases is related to misdiagnosis. Main problems are the differentiation between epileptic and non-epileptic seizures, the differentiation between event related seizures and epilepsy, the analysis of auras and absences. And even the differentiation between focal and generalised epilepsies and the diagnosis of idiopathic syndroms seems to be difficult. This study demonstrates the need for specialised epilepsy centers.