Understanding Misdiagnosis in Pediatric Epilepsy: A Prospective Analysis of Predictors and Patterns

The objective of this study was to determine the proportion of children misdiagnosed with epilepsy, to assess the diagnostic accuracy of the AIIMS modified INCLEN Diagnostic Tool for Epilepsy tool in a real-world tertiary setting cohort and to identify predictors of this condition.

From January to December 2024, a prospective study was carried out at a tertiary health care facility. Children who were referred to our tertiary center with a previous diagnosis of epilepsy or who were already taking anti-seizure medication, aged one month to 18 years, were recruited. Patients were evaluated with AIIMS modified INCLEN Diagnostic Tool for Epilepsy diagnostic tool and the diagnosis was validated by a pediatric neurologist. The diagnostic agreement was assessed using Cohen kappa and predictors of misdiagnosis were found using logistic regression.

Among the 438 enrolled epilepsy patients, 53 (12.1%) patients were misdiagnosed as having epilepsy when events were nonepileptic in nature. On further evaluation, the most common actual diagnosis was migraine, followed by functional/dissociative seizures and movement disorders. There was substantial agreement between the tool and expert diagnosis. Age, father's occupation, and residential status were among the significant predictors. Using logistic regression, age (≥10 years) and urban residency were found to be independent predictors for misdiagnosis.

Misdiagnosis in pediatric epilepsy is common. The study emphasized the importance of structured validated tools in improving accuracy while avoiding misdiagnosis in pediatric epilepsy. These findings highlight the importance of structured clinical assessment in improving diagnostic precision in pediatric epilepsy. Further research is required to assess the effectiveness of structured screening tools in primary and district-level health care settings.