Epileptic and non-epileptic seizures commonly misdiagnosed

Research found that misdiagnosis of epileptic seizures and non-epileptic seizures is common.

A graduate student in Semel Institute for Neuroscience and Human Behavior, and two of his undergraduate trainees, were selected by the Council on Undergraduate Research to present their original research on Capitol Hill in Washington, D.C., on April 29.

Wesley Kerr, whose graduate studies will be completed in the UCLA Department of Biomathematics, and his trainees, Akash Patel and Sarah Barritt, will present their poster entitled "Computer-Aided Diagnosis of Epilepsy Using Clinical Information" outlining advances in the use of computational machine learning to help clinicians detect and diagnose epilepsy correctly.

"A large fraction of patients with seizure disorder are misdiagnosed and treated inappropriately," Cohen said. "As such treatments carry their own risks and negative side effects, their research could positively affect the lives of millions of Americans."

The goal of Kerr's team was to estimate the probability of epilepsy versus non-epileptic seizures based on the historical factors reported by the patient to their neurologist.

Distinguishing between epileptic and non-epileptic seizures is a challenge, Kerr said. On average, the time from the first seizure to the diagnosis of non-epileptic seizures is seven years. In the meantime, a majority of those patients are misdiagnosed with epilepsy and treated inappropriately with anti-epileptic medications.

"This can expose patients to serious, and potentially fatal, side effects," Kerr said. "One of our laboratory's goals is to create an automated system that can aid physicians in distinguishing patients with epileptic and non-epileptic seizures."

Kerr and his team accomplished this by inspecting outpatient clinical notes from patients with medication-resistant seizure disorder, who were later diagnosed as having epilepsy or non-epileptic seizure disorder, using the gold standard diagnostic assessment, 72- hour in-patient closed circuit video-electroencephalography (VEEG) monitoring.

Using a combination of the known risk factors for epilepsy and non-epileptic seizures reported in 228 clinical notes the team examined, their algorithm achieved a diagnosis accuracy of 65%. While at first glance this may appear low, it is comparable to the accuracy of neurologists prior to VEEG monitoring. In this work, they used a machine learning method known as a "decision tree."

"The structure of our decision tree also provided meaningful information about the interpretation of each risk factor in each patient. For example, the risk factors for non-epileptic seizures may not be the same for women and men," Kerr said. "This work may help diagnose, and thereby more effectively treat, patients that are in need."

In addition to serving patients with seizure disorder, the computer-aided diagnostic methods developed by Kerr and his team may be applicable to the diagnosis of other maladies in the future.

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Study of Non-Epileptic Seizures Produced Surprising Results

This study discusses the results of a study showing the differences between epileptic seizures and non-epileptic seizures.

A Loyola University Medical Center neurologist is reporting surprising results of a study of patients who experience both epileptic and non-epileptic seizures.

Non-epileptic seizures resemble epileptic seizures, but are not accompanied by abnormal electrical discharges. Rather, these seizures are believed to be brought on by psychological stresses.

Dr. Diane Thomas reported that 15.7 percent of hospital patients who experienced non-epileptic seizures also had epileptic seizures during the same hospital stay. Previous studies found the percentage of such patients experiencing both types of seizures was less than 10 percent.

Thomas reported the findings Dec. 2 at a meeting of the American Epilepsy Society. The finding is significant because epileptic and non-epileptic seizures are treated differently. Non-epileptic seizures do not respond to epilepsy medications, and typically are treated with psychotherapy, anti-depressants, or both, Thomas said.

Non-epileptic seizures used to be called pseudoseizures. But they are quite real, and the preferred term now is psychogenic non-epileptic seizure. A non-epileptic seizure can resemble the convulsions characteristic of a grand mal epileptic seizure, or the staring-into-space characteristic of a petit mal epileptic seizure. But unlike an epileptic seizure, the brain waves during a non-epileptic seizure are normal.

Non-epileptic seizures can be triggered by stresses such as physical or sexual abuse, incest, job loss, divorce or death of a loved one. In some cases, the traumatic event may be blocked from the patient's conscious memory.

Non-epileptic seizures often are mistaken for epileptic seizures. While some patients who have both types can distinguish between the two, others find it difficult to distinguish when they are having non-epileptic seizures.

The only way to make a definitive seizure diagnosis is to monitor a patient with an electroencephalogram (EEG) and a video camera. (The EEG can detect abnormal electrical discharges that indicate an epileptic seizure.) The patient is monitored with the camera until a seizure occurs, and the EEG recordings from the event are then analyzed.

Thomas conducted her study at the University of Maryland Medical Center, where she did a fellowship in epilepsy before recently joining Loyola. Thomas and colleagues reviewed 256 patients who had come to the hospital to have their seizures monitored. Seventy of the patients had documented non-epileptic seizures. Of these, 11 patients (15.7 percent) also experienced epileptic seizures during their hospital stays.

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