The accuracy of the initial diagnosis after one or more paroxysmal events is described as part of the Dutch Study of Epilepsy in Childhood (DSEC), a prospective hospital-based study of children with newly diagnosed possible single or multiple seizures. A panel of 3 pediatric neurologists classified events as epileptic seizures, unclear episodes, or events of definitely other origin. Children with unclear events were followed for 1 year and children with a diagnosis of seizures were followed for 2 years to assess the accuracy of the diagnosis. Single events in 224 children were classified initially as epileptic in 170(76%) and unclear in 54(24%). An epileptic diagnosis proved correct on follow-up in all 170 patients. Recurrent episodes permitted a definite epilepsy diagnosis in 4(7.4%) of the 54 children with unclear events. Multiple events in 536 children were classified initially as epilepsy in 412(77.7%), and after follow-up the diagnosis was probably incorrect in 19(4.6%). In contrast, 7(5.6%) of 124 children with multiple episodes initially diagnosed as unclear were later classified as epilepsy. A false-positive diagnosis of epilepsy was made in 4.6%, whereas a definite diagnosis of epilepsy was delayed in 5.6% of children with multiple unclear events and in 7.4% of children with a single unclear event. The sensitivity of the diagnosis of an epileptic seizure after a single paroxysmal event was 97.7% and the specificity 100%; after multiple events, the epilepsy diagnosis sensitivity was 98.3% and specificity 86%. Epileptiform abnormalities in the EEG confirm the diagnosis of epilepsy after multiple events in 90.1%, and their absence negates the diagnosis in 46.9%. (sensitivity, 70.3%; specificity, 77.2%). [1]

COMMENT. The authors advise a conservative approach in children with paroxysmal events of uncertain nature. A false-negative diagnosis of epilepsy is considered less harmful for the patient than a false positive. It is of interest that in two events associated with teeth brushing and hair combing, despite an epileptiform EEG, a diagnosis of reflex epilepsy was rejected in favor of “hairdresser’s syncope.”