History versus. Epilepsy Monitoring Unit Evaluation for Diagnosing Seizures: A Concordance Study

Abstract

History is of paramount importance in the diagnosis of epilepsy. Accurate history can help select patients who require a comprehensive Epilepsy Monitoring Unit (EMU) evaluations, i.e. long term EEG monitoring, dedicated structural/functional neuroimaging and neuropsychological evaluation. A detailed history could help delineate seizure subtype and may obviate the need for a comprehensive evaluation, and be cost effective. We compared epilepsy diagnosis made in outpatients using historical information to comprehensive EMU evaluation. We reviewed seizure/spell diagnosis on consecutive patients made on the basis of history and compared to the final diagnosis following comprehensive EMU evaluation. This study was conducted in King Fahad Medical City, Riyadh, Saudi Arabia. Ninety Six patients (Male-51, Female-45) with mean (±SD) age 24(±10.1) years and duration of epilepsy 11(±9.7) years were recruited following outpatient evaluation probable diagnosis of focal seizure was made in 37, generalised in 29, Paroxysmal Non Epileptiform Seizures (PNES) in 6, and evaluation was inconclusive for seizure type in 24 patients. Following EMU evaluation diagnosis of focal epilepsy was made in 61, generalized epilepsy in 26, and PNES in 10 patients. Outpatient diagnosis was concordant to comprehensive EMU evaluation in 45% (43/96), which was 44% (27/61) for focal seizure, 42% (11/26) for generalised and 50% (5/10) for PNES. Concordance was seen in less than half of the patients recruited and was similar for all seizure subtypes. This study highlights the deficiency of accurate history probably related to the language barrier and or lack of health and educational literacy and signifies the importance of EMU evaluation in our population.