The diagnosis of epileptic and non-epileptic seizures☆
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.