On the Misdiagnosis of Non-epileptic Seizures as Tonic-Clonic Seizures: Challenges and Recommendations

Abstract

Many seizures are a result of epilepsy. In contrast, other episodes, known as non-epileptic seizures(NES), are not caused by abnormal electrical signals in the brain and are, therefore, not a direct cause of epilepsy; however, NES episodes are commonly misdiagnosed as tonic-clonic seizures. The misdiagnosis of NES episodes can result in the inapt use of antiepileptic drugs, which have no beneficial effect for people with NES and are commonly used to prevent further epilepsy-induced seizures, leading to the high risk of side effects and the unnecessary payment for these expensive medications. Other consequences of misdiagnosis include limitations on education and employment prospects, the underlying condition going unrecognized and untreated, and a decline in the quality of life of the subject. Although an electroencephalogram(EEG) can be utilized to detect if a convulsion is a result of epilepsy, the test is not entirely accurate and can all the same result in misdiagnosis and its subsequent consequences. It is vital that the EEG is improved to avoid the negative ramifications of the misdiagnosis of NES as tonic-clonic seizures. In this paper, significant flaws with the EEG and other tests used to diagnose tonic-clonic seizures are addressed and characterized in terms of their specificity and sensitivity, and methods to reduce unnecessary brain waves in brain mapping and neuroimaging such as sedation are proposed. Furthermore, auxiliary solutions such as making alterations in the placements and types of electrodes to the conventional method(10/20 system) when performing an EEG as well as alternate tests are considered with the goal of increasing the true positive rate of the diagnosis of epilepsy.