Diagnostic Delays in Children With Early Onset Epilepsy
In the December issue of the journal, Epilepsia, Drs. Berg and colleagues from Children’s Hospital in Chicago and other institutions present an important analysis about the impact of a delay in diagnosing children with early onset epilepsy. In this particular study, children who developed epilepsy before their third birthday were identified in a prospective community-based study. The investigators defined a delayed diagnosis as an interval more than one month from the second seizure to diagnosis. Up to three years of IQ were tested in addition to detailed parental baseline interviews and medical record reviews to identify the reasons for the delay.
Of 172 children in this group, diagnostic delays occurred in 41% of them.
Delays occurred less often if the children
1. had received medical attention for their first seizure,
2. had a history of neonatal febrile seizures,
3. had only convulsions before diagnosis or
4. had a college-educated parent.
A greater than one month diagnostic delay was associated with an average 7.4 point drop in Vineland scales of adoptive motor sports. This effect was present at diagnosis and persisted for at least three years, and it was apparent in IQ scores eight to nine years later that were lower in association with the diagnostic delay by 8.4 points, for processing speed up to 14.5 points and for full scale IQ after adjustment for parental education and other factors.
Factors after adjustment for parental education and other clinical factors associated with delayed diagnosis include:
-- Parents not recognizing the events as seizures
-- Pediatricians missing or deferring diagnosis
-- Neurologists deferring diagnosis
-- Scheduling problems
The authors conclude that diagnostic delays occur in many young children with epilepsy, delays are associated with decremented development IQ later in childhood, and these are opportunities for us to improve our healthcare services.
by Joseph I. Sirven, MD
Last Reviewed: 1/22/2014