Elsevier

Epilepsy Research

Volume 57, Issue 1, November 2003, Pages 59-67
Epilepsy Research

The diagnosis of epileptic and non-epileptic seizures

https://doi.org/10.1016/j.eplepsyres.2003.10.014Get rights and content

Abstract

The aim of this prospective population-based study was to systematically define a cluster of diagnostic items which can assist in the early identification and classification of epileptic and non-epileptic seizures. A cohort of patients aged ≥14 years, suspected with a first epileptic seizure, were included in this study. A team of neurologists evaluated and classified all cases. Diagnostic items for epileptic and non-epileptic seizures were identified using logistic regression analysis. Three hundred and fifty cases entered this study. Distinctive features for epileptic seizures were postictal confusion (OR 0.09), an epileptiform EEG pattern (OR 0.02), and abnormal neuroimaging findings (OR 0.07), whereas for non-epileptic seizures of organic origin there was a history of hypertension (OR 7.5), and provoking factors (OR 13.4) such as exercise and warmth. Diagnostic items for seizures of non-organic origin were a history of febrile seizures (OR 5.8), treatment by a psychologist or psychiatrist (OR 9.1), and presentiment of the seizure (OR 3.7) such as a feeling of choking and palpitations. A separate analysis for the patients who were systematically investigated provided some additional diagnostic items for the different subgroups of patients. For instance, back arching during the seizure for the patients with seizures of non-organic origin and female sex for the patients with non-epileptic seizures of organic origin.

Introduction

Despite several developments in the investigation of epilepsy, including functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and improvements in video-EEG monitoring technology, there is still no test sufficiently sensitive or specific enough to reliably diagnose epileptic seizures.

Accordingly, the correct diagnosis and classification of epileptic seizures depends highly on the extent and quality of evidence acquired at the time of initial diagnosis and on additional evidence accumulated over time. However, it is not yet clear which items of the patient’s history, which findings of the physical examination and which diagnostic tests are of particular importance in diagnosing epilepsy and epileptic seizures.

Population-based studies conducted in a well-defined population have the advantage that they can contribute to a comprehensive characterization of seizures and epilepsy. They provide a representative sample, which allows unbiased evaluations of several variables of interest (Knottnerus, 1987, Knottnerus and Leffers, 1992).

In this prospective population-based study, we attempted to identify in a systematic way criteria which can assist in the early identification and classification of epileptic and non-epileptic seizures. For this purpose, we evaluated in a standardized manner all patients with possible epileptic seizures recruited from a well-defined population.

Section snippets

Study population

The investigation was conducted as part of an ongoing prospective population-based study in Maastricht and its surroundings, a well-circumscribed area located in the southern part of the Netherlands. This area, which lies within the zip-code area 6200–6299, includes 90 general practitioners and one hospital, Maastricht University Hospital. The baseline survey was conducted from October 1998 until October 2000 and included all patients aged ≥14 years of age suspected with a first epileptic

Study population

A total of 350 cases were entered in the study. There were 163 (46.6%) men and 187 (53.4%) women aged between 14 and 92 years (mean, 49 years for men and 51 years for women). In all, 71.1% of the patients were examined in a standardized manner by one of the authors (IK), whereas 28.9% of the patients were not seen by this author. Unprovoked seizures were diagnosed in the majority of the cases (49.7%), followed by non-epileptic seizures of organic origin (22.3%), non-epileptic seizures of

Discussion

In this study the definite diagnosis was obtained six months after the index seizure. Given the largely clinical nature of the diagnostic process, it is unlikely that this diagnosis in all cases is perfectly accurate. However, as Berg et al. (2000) have noted, in most of the cases, it is possible to identify and classify epilepsy early at the time of initial diagnosis. The authors reported that two years after the initial diagnosis of epilepsy syndromes in a cohort of children with newly

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This study has been approved by the Medical Ethical Committee in Maastricht and all participants gave informed consent to it.

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