Distinguishing epileptic seizures from imitators: A video-based evaluation of non-epileptologist physicians

Abstract

Objectives

Epileptic seizures can present with various clinical manifestations, often resembling other conditions—referred to as “imitators of epileptic seizures”—making differential diagnosis challenging. Among them, psychogenic non-epileptic seizures (PNES) or functional/dissociative seizures (FDS) are particularly prevalent in females. This study aimed to evaluate the ability of various non-epileptologist physicians to distinguish epileptic seizures from imitators by viewing video recordings of several paroxysmal events. We also assessed whether variables, such as medical specialty and years of professional experience, could impact diagnostic accuracy.

Materials and methods

Ten video recordings of authorized informational material were presented to non-epileptologist physicians. Five videos depicted non-epileptic events, including syncope, hyperkinetic movement disorder episodes, cataplexy, PNES/FDS, and REM behavior disorder. The remaining videos featured focal and generalized seizures. Participants completed an anonymous questionnaire to classify each event as epileptic or non-epileptic.

Results

Seventy specialists (44 men, 26 women) from psychiatry (12.9%), internal medicine (12.9%), neurosurgery (14.3%), neurology (14.3%), emergency (18.6%), anesthesiology. (18.6 %) and others (7.1 %) were enrolled. The mean age was 49.9 ± 8.7 years; years of work experience were 0–20 years for 53 % and 21–40 years for 47 %. Epileptic seizures were correctly. recognized in 50.3% of cases, whereas non-epileptic paroxysmal events were. misdiagnosed in 49.7% of cases. The most accurately recognized event was tonic-clonic seizure (88.6%), while the most frequently misdiagnosed was PNES/FDS (94.3%).

Discussion and conclusion

Correctly diagnosing epileptic and non-epileptic paroxysmal events can be challenging when relying solely on video recordings. This study highlights the importance of implementing training for adequate diagnosis and subsequent correct management of these conditions.