癫痫常见临床误诊原因分析

目的通过对癫痫和非癫痫误诊病例及24小时脑电图确诊癫痫患者的临床特点分析,提高癫痫的诊断率,减少癫痫误诊。方法纳入四川大学华西医院2009年10月～2011年4月收治的误诊病例及经脑电图确诊的癫痫患者共172例,分析其误诊原因和临床特点。结果在纳入的172例患者中99例非痫性发作误诊为癫痫发作,43例癫痫发作误诊为非痫性发作,30例经24小时脑电图确诊为癫痫。癫痫最易被误诊为短暂性脑缺血发作(TIA)、晕厥、假性发作。反之,非癫痫发作误诊癫痫发作多见于假性发作、TIA。对24小时脑电图确诊的癫痫发作患者的临床特点分析发现不自主咂嘴合并吞咽动作、上腹部不适是最常见待诊患者的临床表现。结论熟练掌握癫痫与非癫痫发作性疾病的临床表现,仔细询问病史,认真做好体格检查,结合脑电图尤其是24小时视频脑电图等检查进行综合分析,可以减少癫痫的误诊,提高癫痫的诊断率。

Analysis of causes of clinical misdiagnosis of epilepsy

ObjectiveTo improve the diagnostic accuracy of epilepsy through analyzing the misdiagnosed cases of epileptic and non-epileptic seizures as well as cases with confirmed epileptic seizures by 24-hour Video Electroencephalogram (24-hour VEEG).MethodsClinical data of misdiagnosed cases and cases with confirmed epileptic seizures were collected though Oct 2009 over April 2011 from West China Hospital.ResultsTotal 172 cases were enrolled into this study,99 with misdiagnosed epileptic seizures were identified as non-epileptic and 43 misdiagnosed non-epileptic seizures were confirmed as epileptic and 30 cases with previous uncertain diagnosis were finally testified to be epilepsy though 24-h VEEG.TIA,Syncope,pseudoseizure were most easily misdiagnosed as epileptic attack.By contrast,epileptic seizures were more likely to be misdiagnosed as pseudoseizure and TIA.Additionally clinical features of those with previous uncertain diagnosis were movement of chewing and swallowing and symptom of epigastric discomfort.ConclusionThe knowledge of clinical manifestation,detailed history-taking,careful physical examination,combined with 24-h VEEG should be required to make correct misdiagnosis of epileptic or non-epileptic seizures.