Focal Epilepsy in Adoloescents Often Misrecognised - EMJ

Undiagnosed Focal Epilepsy in Adolescents Often Misrecognised in Emergency Departments

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A RECENT study sheds light on the challenges adolescents with undiagnosed focal epilepsy face when seeking evaluation in emergency departments (ED). The study, conducted as a retrospective analysis of enrolment data from the Human Epilepsy Project (HEP), emphasises the crucial role of accurate history-taking in prompt diagnosis and treatment. 

Led by Nora Jandhyala, Department of Neurology, NYU Langone Health, New York, USA, this study analysed data from 83 adolescents, aged 12–18 years, enrolled in the HEP between 2012–2017. Alarmingly, 70% of these adolescents had visited an ED before receiving a diagnosis of epilepsy. 

Although most ED presentations were for motor seizures, occurring in 90% of cases, a significant portion of patients had a history of non-motor seizures. However, non-motor seizures were less likely to be correctly identified in the ED, with only 33% recognition compared to 81% for motor seizures. 

Furthermore, adolescents with initial non-motor seizures were less likely to present to EDs, exacerbating the gap in recognition and treatment. Shockingly, none of the adolescents who presented for a first-lifetime motor seizure had their history of initial non-motor seizures recognised in the ED. 

The study highlights a critical need for improved recognition of non-motor seizures, particularly in adolescents presenting with focal epilepsy symptoms in EDs. Researchers stressed the importance of physicians inquiring about non-motor seizure symptoms, even when the presenting seizure is motor, to ensure timely and accurate diagnosis and treatment. Future interventions should focus on addressing this treatment gap to better support adolescents with focal epilepsy in ED settings. 



Jandhyala N et al. Unrecognized focal nonmotor seizures in adolescents presenting to emergency departments. Neurology. 2024;102(10):e209389.  

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