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Reversing the myth of phase reversals

The misdiagnosis of epilepsy is and has always been common in both adults and children [1,2]. Approximately 30% of patients with drug-resistant seizures seen at epilepsy centers do not have epilepsy and have been misdiagnosed [3]. Often, the erroneous diagnosis is based on normal EEG patterns misinterpreted as epileptiform [4]. Epilepsy is a clinical diagnosis and heavily relies on accurate history, as many patients with epilepsy may have normal MRIs and normal routine EEGs [5,6]. The diagnosis of epilepsy can be and (usually is) accurately made without EEG-video or imaging when the history is appropriately suggestive of seizures, while a definitive diagnosis will require capturing the seizure on EEGvideo monitoring. Although tests should not paramount clinical judgment; an erroneous diagnosis is often made due to a vague history and an overread (thus misread) EEG, with overemphasis on EEG [6]. The most common reason for over-reading EEGs is themisinterpretation of normal variants or normal fluctuations of background rhythms [3–7].