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Epilepsy is misdiagnosed in 90 000 people a year in England and Wales

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:824
  1. Roger Dobson
  1. Abergavenny

    Each year more than 90 000 people in England and Wales are wrongly given a diagnosis of epilepsy, a new study has estimated. This scale of misdiagnosis may be resulting in unnecessary costs of as much as £138m (€205m; $257m) a year, it says.

    The study, which was published ahead of print publication on 29 September in Seizure (, doi: 10.1016/j.seizure.2006.08.005), says that diagnosing epilepsy is difficult and that misdiagnosis occurs in one in four cases, largely as a result of patients being seen by medical practitioners who are not specialists in epilepsy.

    The study's authors, from the Health Services Management Centre at Birmingham University and the National Collaborating Centre for Primary Care at the University of Leicester, recommend that “all individuals with a recent onset suspected seizure need to be seen as soon as possible by a specialist medical practitioner with training and expertise in epilepsy.”

    Commissioners of health care should minimise misdiagnosis by ensuring that recent national evidence based guidelines on the management of epilepsy are followed, say the authors, who also developed the 2004 guidelines on epilepsy of the National Institute for Health and Clinical Excellence, the body that advises on use of drugs in the NHS.

    People with a misdiagnosis may experience social and financial deprivation, the report says, and in a small number of cases some people may die prematurely.

    Little is known about the costs of misdiagnosis of epilepsy in the United Kingdom. One relevant study, published more than 10 years ago, focused on epilepsy in general and not on the specific costs of misdiagnosis, says the report.

    The authors used standard costing methods and data from published UK studies on the prevalence of epilepsy and of misdiagnosis and associated costs.

    Given a prevalence of epilepsy of 7.7 cases in every 1000 people and a misdiagnosis rate of 23%, the researchers estimated that in 2002 in England and Wales 92 000 people were wrongly given a diagnosis of epilepsy.

    The report says that the average medical cost per patient each year of misdiagnosis was £316. It says that the main reasons for the costs are inpatient admissions (accounting for 45% of the total costs), inappropriate prescribing of antiepileptic drugs (26%), attendances at outpatient clinics (16%), and care from GPs (8%).

    “The estimated annual medical costs in England and Wales were £29m, while total costs (including community based services costs) could reach up to £138m a year,” the authors wrote.

    “This study highlights the serious health consequences for the patients who are misdiagnosed and notes the high rates of potentially avoidable inpatient admissions, outpatient attendances and GP consultations, and the inappropriate prescribing of antiepileptic drugs,” they add.

    A correct diagnosis of epilepsy requires the clinician to differentiate between seizures and other causes of transient neurological disturbance and collapse, such as syncope.

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