Abstracts

Paroxysmal neurological deficits following epileptic seizures or other medical conditions frequent lead to admission on a Neuro-ICU. The etiological misinterpretation of such events may cause a delayed begin of treatment or an inappropriate utilization of diagnostic- and ICU-capacities., The data of 208 patients being admitted to a Neuro-ICU because of episodic neurological deficits, loss of consciousness and unclear motor phenomena have retrospectively been analyzed. The initially suspected diagnosis in the neurological emergency room was compared to the final diagnosis and the proportion of misdiagnosis was related to the patients[apos] history and diagnostic data respectively., 13.9% of the episodes initially suspected as epileptic seizures proved to be non-epileptic events (NEE). 76% of those patients with [ldquo]misdiagnosed[rdquo] NEE had a prior history of epilepsy. The rate of misdiagnosed NEE was higher in patients with regular EEG-findings (16.7% vs. 8.7%) and regular CT findings (21.2% vs. 11.4%).
15.6% of the epileptic seizures were falsely interpreted to be non-epileptic (6.7% with status epilepticus). The rate of misdiagnosed epileptic Seizures (MES) was higher in patients with newly diagnosed epilepsy if compared to known epilepsy (11.2% vs. 1.4%), whereas the rate of misdiagnosed status epilepticus was independent from a prior history of epilepsy (6% vs. 5.4%). The rate of MES was significantly higher in patients with pathologic CT findings (18.9% vs. 1.8%) and pathologic MRI findings (16.3% vs. 3.3%) respectively. MES were most frequent in patients with hydrocephalus, microangiopathy in CT/MRI and prior neurovascular insults., Our data reveille a known epilepsy and the lack of pathological findings on EEG, CT to be risk factors for the misdiagnoses of non-epileptic paroxysmal events, whereas no prior history of epilepsy and pathologic findings on CT and MRI more often caused a misinterpretation of epileptic seizures to be other neurological disorders.,