Diagnosis of epilepsy over the course of the disease

At the onset of the disease, differential diagnosis should be established between an epileptic seizure and a series of paroxysmal phenomena, such as syncope, pseudoseizure, or migraine aura, which may manifest with similar symptoms. But even when the initial differential diagnosis is established rigorously, we will see that it is often necessary to reconsider the diagnosis of epilepsy during the course of the disease.

Prospective studies analyzing initial recognition of epilepsy found that on half of occasions the diagnosis was reached late, when the patient had already suffered repeated seizures. On other occasions, it is noted that, although the diagnosis of epilepsy was correct, the epileptic syndrome of the patient was classified erroneously, which can lead to inappropriate management. There are a number of reasons that can explain these delays or errors in diagnosis, and we will devote this entire article to their discussion.

Based on a detailed medical history and with the aid of the electroencephalogram and magnetic resonance imaging, the diagnosis of epilepsy can be made and the specific epileptic syndrome identified in many patients from the time of the first seizure. However, various studies show that it is often necessary to modify the initial diagnosis during the follow-up of a patient because of progression of the disease itself (infantile stage), a previous diagnostic error, or because of diagnostic difficulties or inadequate interpretation of tests such as the electroencephalogram or magnetic resonance imaging.