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The incidence and prevalence of epilepsy

Diagnostic accuracy is a particular problem in epilepsy as seizures are a symptom of diverse underlying cerebral aetiologies and normally do not have any physical manifestations. Consequently a definitive diagnosis of epilepsy is often only made after an extended period of follow up, as evidenced in the Rochester study and the National General Practice Study of Epilepsy (NGPSE), a community-based study of epilepsy in the United Kingdom. Moreover it has been found that 20−30% of those attending tertiary referral centres with refractory epilepsy do not in fact have epilepsy, with the most common differential diagnoses being dissociative seizures and syncope. As expected, neurologists are better at the diagnosis of epilepsy than non-specialists (mistake rate 5.6% vs 18.9%) but a misdiagnosis rate of 5% should be considered as the absolute minimum.