Abstracts

Rationale: The diagnosis of seizure/epilepsy is made clinically; the clinical impression can vary remarkably based on the availability of an eye witness account and the knowledge of the clinician who must ask certain key questions. Also, clinicians (improperly) rely heavily on tests, primarily the electroencephalogram (EEG) and brain magnetic resonance imaging (MRI). In this study, we assessed seizure experts’ confidence in their clinical diagnosis (before EEG and MRI) and compared the diagnosis before and after testing, i.e. the intra-observer variability to assess the importance of the seizure evaluation in making a diagnosis for patients being seen in a FIRST SEIZURE clinic.  Methods: Patients referred for an apparent first seizure to an academic epilepsy outpatient practice setting were enrolled prospectively in this study. Data for 46 patients were reviewed. All the patients were evaluated by a fellowship trained epilepsy expert neurologist and EEG/MRI tests were ordered for a future follow up visit. Physicians completed a brief questionnaire where they were asked to check off one of these options: epileptic seizure, syncope, psychogenic seizure or other medical conditions for a diagnosis then they were asked to rate their confidence in the diagnosis as low, moderate and high. After the tests were completed the physicians completed a similar questionnaire at the second visit. The diagnostic test results were available for only 25 patients who were included in our analysis. Kappa statistic was used to measure the intra-observer variability. Descriptive statistics was used to summarize the demographic and clinical characteristics of the study population.  Results: Patient demographics and clinical characteristics are presented in Table 1. Eye witness account of the seizure event was reported in 76% (19/25) cases. Intra-observer agreement of epilepsy diagnosis between the first and second visit was 92% with a kappa statistics of 0.72. Most of the time clinicians (72%; 18/25) were highly confident of their diagnosis while 28% of them were moderately confident during the first patient encounter. During the second visit 92% (23/25) clinicians had very high confidence in their diagnosis of epilepsy while 8% were moderately confident. None of the physician reported low confidence in their diagnosis during both the visits.  Conclusions: Epilepsy experts showed strong agreement in diagnosis between first and second visits when evaluating patients referred after an apparent first seizure. Most of the time the diagnosis did not change after the EEG/MRI were performed.  Funding: none