Common errors made in the diagnosis and treatment of epilepsy.
Learning from one's mistakes is the best learning tool in medicine and this applies as well to epilepsy. This article is a compilation of some of the frequent mistakes that are made in the evaluation and management of patients with epilepsy. It encompasses errors in the clinical diagnosis that result in the choice of the erroneous antiepileptic drug (AED), errors in the way auxiliary tests like the electroencephalogram and magnetic resonance imaging studies are ordered, mistakes in the recognition of subclinical status epilepticus, errors in the selection of AEDs, consequences of the failure to factor in the pharmacokinetic and pharmacodynamic properties of AEDs in the choice and dosification of medication, misconceptions on the expectations of therapeutic effect of AEDs, delay in recognition of refractory epilepsy with consequent delay in a timely identification of patients whose epilepsy can be cured with surgical treatment, and mistakes in the recognition and management of comorbid psychiatric disorders. In addition to a discussion of the reasons for the errors, the article provides practical solutions.
Kanner
Andres M
AM
Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA. akanner@rush.edu
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D003952:Diagnostic Imaging / Q000592:standards; D054796:Drug Dosage Calculations; D004351:Drug Resistance / Q000502:physiology; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000209:etiology
D000927:Anticonvulsants