Misdiagnosis of epileptic and non-epileptic seizures in a neurological intensive care unit.
OBJECTIVE
The etiological misinterpretation of paroxysmal neurological symptoms frequently causes a delayed treatment or an inappropriate utilization of ICU-capacities.


METHODS
In this study, the data of 208 patients admitted to a neurological ICU because of acute transient neurological deficits, loss of consciousness or unclear motor phenomena were retrospectively analyzed. The initial emergency room diagnosis was compared to the final diagnosis and the rate of misdiagnosis was related to the patients' history and diagnostic data.


RESULTS
In 13.9%, the emergency room diagnosis of epileptic seizures turned out to be incorrect, whereas in 15.6%, the final diagnosis of epileptic seizures was missed in the emergency room. Factors that were significantly correlated to missing the seizure diagnosis were (i) no prior history of epilepsy, (ii) old age, (iii) multi-morbidity, (iv) pathologic CT-scans demonstrating cerebrovascular lesions, (v) seizure description by non-professionals, (vi) predominantly negative seizure phenomena (aphasia, loss of consciousness, paresis), (vii) lack of tongue-bite lesions.
Boesebeck
F
F
University of Muenster, Department of Neurology, Muenster, Germany. boesebeck@diako-online.de
Freermann
S
S
Kellinghaus
C
C
Evers
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012640:Seizures / Q000175:diagnosis*; D055815:Young Adult