Over- and underreporting of seizures: How big is the problem?

Area of Science:

• Neurology
• Clinical Neurophysiology

Background:

• Accurate seizure reporting is vital for epilepsy patient management.
• Discrepancies exist between patient-reported seizures and electroencephalographic (EEG) findings.
• Underreporting of seizures is recognized, but overreporting is less understood in large cohorts.

Purpose of the Study:

• To quantify the extent of seizure over- and underreporting in a large cohort of patients undergoing ambulatory EEG.
• To analyze the types of reported events (epileptic, psychogenic, non-correlated) in relation to EEG findings.

Main Methods:

• Retrospective analysis of 3407 patients undergoing ambulatory video-EEG from 2020-2022.
• Classification of 21,024 recorded events as epileptic, psychogenic, or non-correlated events (NCEs).
• Analysis of events based on arousal state, referral indication, and epilepsy type (focal vs. generalized).

Main Results:

• 27% of all events were epileptic seizures, with 64% of these underreported by patients.
• 58% of reported events were NCEs, more common in awake/drowsy states and various referral indications.
• NCEs were significantly higher in focal epilepsy (23%) compared to generalized epilepsy (10%).

Conclusions:

• The study confirms underreporting and highlights significant overreporting of non-epileptic events in ambulatory EEG.
• Identifying NCEs is clinically relevant, potentially representing irrelevant symptoms or artifacts.
• Further research into risk factors and the etiology of NCEs is warranted.