Common Errors Made in the Diagnosis and Treatment of Epilepsy
Common Errors Made in the Diagnosis and Treatment of Epilepsy
Learning from one's mistakes is the best learning tool in medicine and this applies as well to epilepsy. This article is a compilation of some of the frequent mistakes that are made in the evaluation and management of patients with epilepsy. It encompasses errors in the clinical diagnosis that result in the choice of the erroneous antiepileptic drug (AED), errors in the way auxiliary tests like the electroencephalogram and magnetic resonance imaging studies are ordered, mistakes in the recognition of subclinical status epilepticus, errors in the selection of AEDs, consequences of the failure to factor in the pharmacokinetic and pharmacodynamic properties of AEDs in the choice and dosification of medication, misconceptions on the expectations of therapeutic effect of AEDs, delay in recognition of refractory epilepsy with consequent delay in a timely identification of patients whose epilepsy can be cured with surgical treatment, and mistakes in the recognition and management of comorbid psychiatric disorders. In addition to a discussion of the reasons for the errors, the article provides practical solutions.
Those who cannot remember the past are condemned to repeat it.George Santayana, The Life of Reason, Volume 1, 1905 This well-known phrase not only applies to political events, societal crises, or personal conflicts, but it is also very pertinent to the practice of medicine. Clearly, if we do not learn from our mistakes and change our way of practicing, we will continue repeating them over and over. In fact, analyzing our errors in a critical way is one of the most effective learning methods in clinical medicine. The purpose of this article is to review some of the most frequently identified mistakes in the evaluation and management of children and adults with epilepsy. It focuses particularly on those mistakes that prevent the achievement of seizure freedom, those that result in a worsening of patients' quality of life, and those with the greatest potential to enhance morbidity and mortality rates. Some of the errors discussed here are addressed in greater detail in various articles of this issue, in which case the reader will be referred to those manuscripts.
The manuscript is divided into three sections. The first is a discussion of common mistakes made in the diagnosis of epileptic seizure disorders, both with respect to reaching a clinical diagnosis of an epileptic syndrome and the implications that this may have on its management. The second section addresses common mistakes made in the management of epileptic disorders, devoting the first part to pharmacotherapy and the second to surgical treatment. Finally, the third section reviews the impact of the failure to recognize and treat comorbid cognitive and psychiatric conditions that are common in epilepsy, and offers very practical approaches to the often controversial use of psychotropic drugs in these patients.
Learning from one's mistakes is the best learning tool in medicine and this applies as well to epilepsy. This article is a compilation of some of the frequent mistakes that are made in the evaluation and management of patients with epilepsy. It encompasses errors in the clinical diagnosis that result in the choice of the erroneous antiepileptic drug (AED), errors in the way auxiliary tests like the electroencephalogram and magnetic resonance imaging studies are ordered, mistakes in the recognition of subclinical status epilepticus, errors in the selection of AEDs, consequences of the failure to factor in the pharmacokinetic and pharmacodynamic properties of AEDs in the choice and dosification of medication, misconceptions on the expectations of therapeutic effect of AEDs, delay in recognition of refractory epilepsy with consequent delay in a timely identification of patients whose epilepsy can be cured with surgical treatment, and mistakes in the recognition and management of comorbid psychiatric disorders. In addition to a discussion of the reasons for the errors, the article provides practical solutions.
Those who cannot remember the past are condemned to repeat it.George Santayana, The Life of Reason, Volume 1, 1905 This well-known phrase not only applies to political events, societal crises, or personal conflicts, but it is also very pertinent to the practice of medicine. Clearly, if we do not learn from our mistakes and change our way of practicing, we will continue repeating them over and over. In fact, analyzing our errors in a critical way is one of the most effective learning methods in clinical medicine. The purpose of this article is to review some of the most frequently identified mistakes in the evaluation and management of children and adults with epilepsy. It focuses particularly on those mistakes that prevent the achievement of seizure freedom, those that result in a worsening of patients' quality of life, and those with the greatest potential to enhance morbidity and mortality rates. Some of the errors discussed here are addressed in greater detail in various articles of this issue, in which case the reader will be referred to those manuscripts.
The manuscript is divided into three sections. The first is a discussion of common mistakes made in the diagnosis of epileptic seizure disorders, both with respect to reaching a clinical diagnosis of an epileptic syndrome and the implications that this may have on its management. The second section addresses common mistakes made in the management of epileptic disorders, devoting the first part to pharmacotherapy and the second to surgical treatment. Finally, the third section reviews the impact of the failure to recognize and treat comorbid cognitive and psychiatric conditions that are common in epilepsy, and offers very practical approaches to the often controversial use of psychotropic drugs in these patients.