Diagnostic guideline adherence in patients with a first epileptic seizure
Summary
Introduction
National guidelines recommend repeating an electro-encephalogram (EEG) in patients
with suspected epilepsy whose first routine EEG (rEEG) and brain imaging is normal or inconclusive.
However, controversy exists regarding the diagnostic value and benefits of various types of additional
EEGs leading to a reduction in guideline adherence. A survey found that 50% of Dutch neurologists
indicated guideline-adherence. Real world data on adherence and the consequences of non-adherence
are lacking.
Methods In this historical cohort study, we evaluated patients who received a rEEG at the
St. Antonius hospital in 2018 after a first unprovoked suspected epileptic seizure. We analyzed
guideline adherence, final diagnosis at follow-up and seizure recurrence rate while not treated with
antiepileptic medication for up to two years in patients who were diagnosed according to the guideline
and patients who were not.
Results A total of 463 patients (235 females; mean age 44±25) were
included. Diagnostics according to guidelines were performed in 31.1% (144/463) patients. Epilepsy
was the most likely diagnosis at follow-up in 11.3% (36/319) patients not diagnosed according to the
guideline and in 50.7% (73/144) patients diagnosed according to the guideline (p<0.01). The recurrence
rate in patients with epilepsy was higher in the guideline non-adherence group (66.7% (24/36) versus
43.8% (32/73), p:0.03).
Conclusion Guideline adherence was low, but the incidence of epilepsy was
also low in patients not diagnosed according to the guideline. Seizure recurrence rates were higher when
the guideline was not followed. This supports guideline adherence but also indicates that better selection
of patients with a reasonable a-priori risk of epilepsy for whom this guideline applies is needed.