Epilepsy is misdiagnosed in 90 000 people a year in England and Wales
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7573.824-a (Published 19 October 2006) Cite this as: BMJ 2006;333:824
All rapid responses
Editor
Misdiagnosis of any disease condition is devastating for the patient.
Not to say if it’s something with so much stigma attached to it. As shown
by the Holton case (i) the impact can be expensive as well.
Approximately 456,000 people are diagnosed with epilepsy in the UK.
The National Institute of Clinical Excellence (NICE) have acknowledged in
their review on Epilepsy in Dec 2003(ii) that the rate of misdiagnosis of
epilepsy in the UK is between 20 – 31%. This accounts for nearly 91,000
and 141,000 being misdiagnosed and taking the antiepileptic medication
having to bear with all their adverse effects(iii).
When NICE guidelines tell us to refer to specialists, we should
remember that one of the most under estimated cause of misdiagnosis of
epilepsy is over reading of EEGs as says Dr. Benbadis ,Associate
Professor of in the 2001 Annual Meeting of the American Epilepsy Society.
(i) BMJ. 2001 December 8; 323(7325): 1323.
(ii) Press Release 27 January 2006: Epilepsy action’s Response to Dr
Holton hearing
(iii) The Clinical Guidelines and Evidence Review for the Epilepsies: the
evidence base for The epilepsies: diagnosis and management of the
epilepsies in adults and children. National Institute for Clinical
Excellence guideline (2004).: Appendix G - Costs of epilepsy misdiagnosis,
first consultation
Competing interests:
None declared
Competing interests: No competing interests
Since the BMJ abstract report (R. Dobson) contains no clinical or
electrographic
criteria for misdiagnosis and the source article is available online only
to
subscribers (access via Athens, denied), it is difficult for many readers
to accept
the assertions and recommendations of this article.
Competing interests:
None declared
Competing interests: No competing interests
Misconcepts about epilepsy
Epilepsy management in UK is still not considered a specialist
activity. There have been recent incidents of unacceptable levels of
epilepsy misdiagnosis, which however do not provoke the same outrage that
errors in cardiac surgery, or pathology does. There are several reasons
for that.
1) Continuing shortage of specialists trained in recognition and treatment
of epilepsy.
2) A Lingering feeling that any specialist can treat epilepsy.
3) No serious consideration for the impact of epilepsy on a child’s/Adults
life and the quality of life issues.
4) Tendency to sweep the issue under the carpet once the acute furore of
misdiagnosis scandals and the SUDEP studies publications are made.
I think the answer is to recognize neurology and epilepsy as a stand-alone
sub speciality because more and more we find the generalists who hold our
purse strings and determine our future do not understand the sub
speciality and its needs. Like the American board of psychiatry and
neurology I would propose a Royal college of neurology encompassing
Neurology, epilepsy and its sub specialities Unless sub specialities are
given their due place we will lag behind much of Europe and the USA in
such matters.
Jayaprakash A Gosalakkal
Competing interests:
A Sub specialist in Paediatric neurology
Competing interests: No competing interests