Improving diagnosis of epilepsy in India--how difficult is it?

Misdiagnosis of seizures and epilepsy is rampant. There are several paroxysmal non-epileptic events (NEE) – like syncope, non-epileptic attacks (earlier called psychogenic or pseudo-seizures), paroxysmal movement disorders, migraine equivalents, parasomnias, nonepileptic staring – which can mimic seizures and confuse even the experienced observer [1,2]. In a prospective study of first ‘seizures’, 39% had NEE [2]; interestingly even when the referring physician was certain of the diagnosis of seizures, more than one-third had NEE. In retrospective studies of first events, syncopal attacks outnumber seizures and the diagnosis remains unclear even after investigations in about one-sixths of all referrals [3].