Rate of misdiagnosis of childhood epilepsy “may not be unusual”BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7385.355/c (Published 15 February 2003) Cite this as: BMJ 2003;326:355
A misdiagnosis rate of almost one in three cases of childhood epilepsy, made by a consultant paediatrician in Leicester, “may not be unusual,” concludes an 18 month investigation of his clinical practice.
But more than 300 families are pursuing legal action against the trust involved, and furious parents continue to press for an independent inquiry.
Dr Andrew Holton was suspended from his post at Leicester Royal Infirmary in May 2001, after an internal review of children's services at the hospital and mounting numbers of complaints from parents and clinicians (BMJ 2001;323:1323). Dr Holton, who was not a paediatric neurologist, had looked after more than 9000 children since his appointment in 1990 and had treated 1948 of them for epilepsy.
The final report, from the University Hospitals of Leicester NHS Trust in association with the British Paediatric Neurology Association, was published last week.
The review found that the diagnosis of epilepsy was incorrect in 618 cases (32%). The case notes of 81 children (4%) are still under investigation.
But the report points out that such a rate may not be unusual, citing preliminary evidence from the Proceedings of the International League Against Epilepsy that shows similar rates of misdiagnosis among generalist paediatricians with an interest in neurology, such as Dr Holton.
The review also substantiated concerns regarding Dr Holton's diagnosis, treatment, and interpretation of electroencephalograms that had been raised in the interim report, which was published in November 2001. Among other things, the interim report said that around a third of the children had been overtreated.
The medical director of the trust, Dr Allan Cole, said: “The trust is confident that all children are now receiving the appropriate treatment for their condition or continue to be investigated to establish a diagnosis.”
A trust spokesperson said that while the evidence on Dr Holton's clinical practice “fell short of dismissal,” the details would be formally recorded at a disciplinary hearing to be held shortly.
A separate internal investigation into Dr Holton's behaviour towards parents and colleagues concluded that “there were occasions when he adopted a wrong approach” but that formal disciplinary action was not warranted.
Dr Holton, who has fully accepted the review findings, is considering retraining in a different specialty outside Leicester. He has also been referred to the doctors' regulatory body, the General Medical Council, and a further report into the whole case, commissioned by the former Trent region, is expected in April.
David Chadwick, professor of neurology at the University of Liverpool, agreed that epilepsy was especially difficult to diagnose in children but said that a percentage of “31.8% is a terrible indictment of epilepsy services.”
Prompted by a national sentinel audit last May, which showed that there were 400 preventable deaths from epilepsy, the government's much delayed action plan is due to be published within the next few weeks.
Review of the Management of Patients with Epilepsy by Dr A Holton between 1990 and May 2001 can be accessed at http://www.uhl-tr.nhs.uk/