Minshew, Nancy J
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چکیده
This is the most difficult aspect of seizure management, clearly the most critical, and yet it receives relatively little attention. Despite the sophistication of electrophysiologic methods for the diagnosis of seizures, the majority of patients will be assessed without the benefit of any technology beyond the routine scalp recording. Unfortunately, physicians are generally quite reluctant to make a clinical diagnosis of seizures. This reluctance arises from a lack of confidence. The current emphasis on elaborate monitoring techniques had made the reluctant clinician even more reluctant to make a clinical judgement, not because he has been confronted repeatedly with errors in his clinical judgement but because of the discomfort he feels in making the diagnosis in the first place; as a result, the possibility of deferring that judgement to a laboratory result becomes the more comfortable choice. Often the patient has so many symptoms that the physician contemplating seizures as the etiology is confronted with an overriding fear of overdiagnosis. In actuality, this fear is unjustified and the diagnostic error is, by far, in the direction of under diagnosis as evidenced by the number of behaviors which respond to the anticonvulsant treatment of “the seizures”.
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