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Observational Study
. 2020 Dec;61(12):2643-2652.
doi: 10.1111/epi.16707. Epub 2020 Oct 19.

Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

Jacob Pellinen  1 , Erica Tafuro  2 , Annie Yang  3 , Dana Price  1 , Daniel Friedman  1 , Manisha Holmes  1 , Sarah Barnard  4 , Kamil Detyniecki  5 , Manu Hegde  6 , John Hixson  6 , Sheryl Haut  7 , Reetta Kälviäinen  8 , Jacqueline French  1 ; Human Epilepsy Project Co-Investigators
Affiliations
Observational Study

Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

Jacob Pellinen et al. Epilepsia. 2020 Dec.

Abstract

Objective: To test the hypothesis that people with focal epilepsy experience diagnostic delays that may be associated with preventable morbidity, particularly when seizures have only nonmotor symptoms, we compared time to diagnosis, injuries, and motor vehicle accidents (MVAs) in people with focal nonmotor versus focal seizures with motor involvement at epilepsy onset.

Methods: This retrospective study analyzed the enrollment data from the Human Epilepsy Project, which enrolled participants between 2012 and 2017 across 34 sites in the USA, Canada, Europe, and Australia, within 4 months of treatment for focal epilepsy. A total of 447 participants were grouped by initial seizure semiology (focal nonmotor or focal with motor involvement) to compare time to diagnosis and prediagnostic injuries including MVAs.

Results: Demographic characteristics were similar between groups. There were 246 participants (55%) with nonmotor seizures and 201 participants (45%) with motor seizures at epilepsy onset. Median time to diagnosis from first seizure was 10 times longer in patients with nonmotor seizures compared to motor seizures at onset (P < .001). The number and severity of injuries were similar between groups. However, 82.6% of MVAs occurred in patients with undiagnosed nonmotor seizures.

Significance: This study identifies reasons for delayed diagnosis and consequences of delay in patients with new onset focal epilepsy, highlighting a treatment gap that is particularly significant in patients who experience nonmotor seizures at epilepsy onset.

Keywords: clinical neurology; complex partial seizures; epilepsy semiology; epilepsy/seizures; partial seizures.

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