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Agreement between initial and final diagnosis of first seizures, epilepsy and non-epileptic events: a prospective study
  1. Howan Leung (howanleung{at}
  1. Chinese University of Hong Kong, Hong Kong
    1. CY Man (manchiyin{at}
    1. Accident and Emergency Department, Prince of Wales Hospital, Shatin, NT, Hong Kong
      1. A CF Hui (huicf{at}
      1. Chinese University of Hong Kong, Hong Kong
        1. K S Wong (ks-wong{at}
        1. Chinese University of Hong Kong, Hong Kong
          1. P Kwan (patrickkwan{at}
          1. Chinese University of Hong Kong, Hong Kong


            Background: To make a diagnosis between first seizure, epilepsy and non-epileptic event is a challenging clinical exercise for many physicians as it may lead to different therapeutic implications. We ascertained the agreement between the initial diagnosis at the accident and emergency(A&E) department and the final diagnosis following in-patient neurological evaluation of seizure disorders.

            Method:A prospective observational study between 4/04 and 6/05 in a regional hospital in Hong Kong recruited 1,701 patients from A&E to neurology/medical wards with initial diagnoses/labels matching any one of twelve pre-defined keywords which were categorised as either “seizure-specific” or “non-specific”.

            Results: Among the 1,170 patients with “non-specific” initial diagnoses/labels, 58 (5%) were finally diagnosed to have had first seizures or epilepsy. Among 531 patients with “seizure-specific” initial diagnoses/labels, 27 (5.1%) were subsequently diagnosed to have had non-epileptic events. The kappa-value for agreement between the initial and final diagnosis was 0.88. Of the 154 patients with final diagnosis of first seizure, 34 (22%) had “non-specific” initial labels. Among these patients, components of the evaluation contributing to revision of diagnosis included retrieval of witness accounts(47%), epileptiform discharges on electroencephalogram(EEG)(47%), short-term monitoring in patients suspected of acute symptomatic seizures(28%) and panel discussion of cases(22%).

            Conclusion: There was generally high degree of agreement between the initial and final diagnosis, but first seizures were often missed initially. Careful history taking, judicious use of EEG, selective short-term monitoring and liaison with specialists are important for reaching an accurate diagnosis.

            • first seizure
            • interrater reliability
            • misdiagnosis

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