![]() ![]() 9–11 One-third of the patients later found to have PNES have had previous EEGs that were interpreted as epileptiform that contributed to the misdiagnosis. Multiple papers have revealed that many patients with non-epileptic disorders such as syncope and PNES have the incorrect diagnosis of epilepsy perpetuated by the misreading of benign EEG patterns. Accuracy in reading EEGs is critical in both identifying patients who have an increased risk of having epilepsy and avoiding the misdiagnosis of epilepsy in patients without epilepsy. 8 These are widely recognized today as non-epileptogenic. 6,7 Studies from the early years of EEG showed higher percentages, usually around 2–4%, because they included 6 and 14Hz positive spikes or six-persecond waves as epileptiform. 4,5 In adults, the percentage is much lower, probably less than 2%. In children, up to 6.8% will have true epileptiform discharges without clinical epilepsy when photic stimulation is used. 2,3 The electroencephalogram (EEG) can be both helpful and misleading in diagnosis. 1 Likewise, in pediatric epilepsy centers, 15–39% have non-epileptic paroxysmal events. Studies in tertiary epilepsy centers have shown that 30% of adult patients referred for intractable ‘epilepsy’ have non-epileptic events, chiefly psychogenic non-epileptic spells (PNES). The accurate diagnosis of epilepsy is difficult. ![]()
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