Focal epilepsy often overlooked
Earlier diagnosis could lead to fewer car accidents

Date:
October 20, 2020
Source:
NYU Langone Health / NYU School of Medicine
Summary:
Having subtler symptoms, a form of epilepsy that affects only
one part of the brain often goes undiagnosed long enough to cause
unexpected seizures that contribute to car crashes, a new study
finds.



FULL STORY ========================================================================== Having subtler symptoms, a form of epilepsy that affects only one part
of the brain often goes undiagnosed long enough to cause unexpected
seizures that contribute to car crashes, a new study finds.


==========================================================================
The study, publishing online Oct. 20 in the journal Epilepsia, addressed
focal epilepsy, the most common form of this brain disorder. Researchers
say the study is among the first to outline failure to recognize symptoms
of subtle seizures as a main reason for the delay in diagnosis.

Led by researchers at NYU School of Medicine, the study shows that it can
take on average two years for physicians to recognize the early signs of
focal epilepsy, particularly in a subset of patients with seizures that
do not involve uncontrolled movements of their arms and legs. Symptoms
of these "non- motor seizures" instead may include a recurring brief hallucination, a strong sense of de'ja` vu, or sensations of a dreamlike
state while awake.

Subtler cases are often not diagnosed until they have progressed to
disruptive "motor" seizures, say the study authors, which can cause the unrestrained, whole-body spasms often portrayed in popular culture.

"Our study highlights how common the early and subtle signs of focal
epilepsy are," says study senior investigator Jaqueline A. French, MD,
a professor of neurology and director of translational research and
clinical trials for epilepsy at NYU Langone Health. "We must do a much
better job of recognizing them before people go undiagnosed, untreated,
and with the potential to cause harm." The World Health Organization
estimates that at least 50 million people worldwide have epilepsy,
including the most common focal epilepsy, affecting one in 26 American
adults. French says medication is highly effective in controlling most
symptoms once a diagnosis is made, but because subtle signs often go undetected, the actual numbers are likely higher than estimated.

For the current study, funded by NYU Langone Health, researchers analyzed
data collected from 447 epilepsy patients between the ages of 12 and
60 who were being monitored over time at 34 epilepsy treatment centers
around the world.

Researchers found that 246 patients were diagnosed as long as six years
after experiencing some history of initial signs of non-motor seizures,
while 201 patients were diagnosed, on average, within two months of
having motor seizures.

Researchers believe the impact of earlier diagnosis in focal epilepsy
patients goes beyond more timely treatment of patients. Among the
study's other findings, 23 patients reported having one or multiple car accidents before their diagnosis. Nineteen of these undiagnosed patients
had non-motor seizures, while four patients had motor seizures. The
researchers estimate that for every 13 early diagnoses, one car accident
could be prevented, or an estimated 1,816 preventable accidents annually worldwide.

"To improve diagnoses, it is critical that physicians not overlook the possibility of a seizure, particularly during emergency room visits
and after any kind of car accident," says study lead investigator
Jacob Pellinen, MD, a recent postdoctoral fellow in the Department
of Neurology's Division of Epilepsy at NYU Langone. "Patients need to
partner with their physicians and be honest about any recurring abnormal
or unusual symptoms they experience," he adds.

All of the patients studied were enrolled in a detailed patient registry,
the Human Epilepsy Project, between 2012 and 2017. The participants,
mostly from the U.S. and Canada, but also from Australia and Europe,
were able to report the frequency and type of their seizures prior to
the study. For the analysis, the self-reported symptoms were combined
with medical records, which included evaluations by a neurologist and information about previous seizure-related injuries and car accidents.

The research team next plans to study patients who go to the emergency
room (ER) after a car accident with early signs of epilepsy to see whether
they are asked about their seizure history,or subsequently evaluated by
a neurologist.

Because an ER visit can be the first time undiagnosed epilepsy patients
are seeing a doctor, it offers a critical opportunity to fix the problem
and prevent subsequent harm, the researchers say.


========================================================================== Story Source: Materials provided by NYU_Langone_Health_/_NYU_School_of_Medicine. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Jacob Pellinen, Erica Tafuro, Annie Yang, Dana Price, Daniel
Friedman,
Manisha Holmes, Sarah Barnard, Kamil Detyniecki, Manu Hegde, John
Hixson, Sheryl Haut, Reetta Ka"lvia"inen, Jacqueline French. Focal
nonmotor versus motor seizures: The impact on diagnostic delay in
focal epilepsy.

Epilepsia, 2020; DOI: 10.1111/epi.16707 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201020081743.htm

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