Epilepsy is a CNS condition characterized by abnormal brain activity and the predisposition to generate unpredictable and unprovoked seizures. The seizures may be of genetic etiology or caused by physical trauma and brain injury. Shorvon et al. (2016) point out that in diagnosing epilepsy, it is important to determine the location of the event, duration of the seizures, the brain part affected, and the profound effects. Family history and electroencephalogram (EEG) reading are also important in diagnosis. Clinical manifestations may often include twitching of extremities and staring blankly for some seconds.
Differential Diagnosis
Non-epileptic seizure conditions such as syncope, transient amnesia, and cardioembolic stroke may manifest similar clinical symptoms and etiology of epilepsy ( Shorvon et al., 2016). Syncope is a self-limiting loss of consciousness accompanied by the loss of postural tone. The altered state of consciousness is often transient and precedes spontaneous recovery. Transient amnesia is characterized by the paroxysmal loss of memory function, accompanied by anxiousness and agitation among the patients. Although TGA is an isolated event, it may occur alongside other CNS conditions such as epilepsy. Stroke occurs when the brain is deprived of nutrients and oxygen, leading to distortion of function that may be manifested as loss of coordination, blank stares, numbness or weakness of extremities, and confusion. Other conditions that may mimic seizures are migraine headaches, encephalitis, sleep disorders meningitis, and eclampsia ( Shorvon et al., 2016).
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Prevalence and Misdiagnosis
According to the World Health Organization (2019), Epilepsy is the most prevalent neurological condition, affecting approximately 50 million people in the world. Most of those affected live in middle- and low-income countries. The senior adults are the most affected population group. Misdiagnosis is one of the leading causes of fatalities among epilepsy patients. About 70% of epilepsy fatalities and complications can be avoided by proper diagnosis. Non-epileptic seizure disorders (NESD) such as syncope and Tourette’s syndrome may often be mistaken for epilepsy, misinforming the treatment and management approaches. Delayed treatment of epilepsy due to misdiagnosis may result in prolonged attacks, refractory epilepsy, teratogenic effects of antiepileptic drugs, morbidity, and mortality (Oto, 2017).
Prevention of Misdiagnosis
Misdiagnosis can be prevented by increasing the certainty of diagnosis through enhanced training and exposure of the clinician and use of effective diagnostic equipment. Clinicians have to avoid over-relying on laboratory tests and EEG readings, as most neurologic conditions involving brain injury and trauma may present indicate the same readings (Oto, 2017).
References
Oto, M. M. (2017). The misdiagnosis of epilepsy: appraising risks and managing uncertainty. Seizure , 44 , 143-146. Retrieved on 30 th August 2019 from https://www.seizure-journal.com/article/S1059-1311(16)30297-7/fulltext
Shorvon, S., Diehl, B., Duncan, J., Koepp, M., Rugg‐Gunn, F., Sander, J., & Wehner, T. (2016). Epilepsy and Related Disorders. Neurology: A Queen Square Textbook , 221-287.
World Health Organization. (2019, June 20 th ). Epilepsy. Retrieved on 30 th August 2019 from https://www.who.int/news-room/fact-sheets/detail/epilepsy
