An advanced workup that includes long-term EEG (LT-EEG) and brain MRI provides “remarkable added value” in the ED for diagnosing new-onset epilepsy versus non-epileptic causes of seizure mimickers, according to results published in Epilepsia. Pia De Stefano, MD, and colleagues examined adults presenting to the ED with a first seizure event (N=1,010). The research team conducted routine EEG, LT-EEG, brain CT, and brain MRI in the initial workup and then calculated sensitivity and specificity for these examinations based on the final diagnosis after 2 years, along with the added value of advanced workup (MRI and LT-EEG) over routine workup (routine EEG and CT). Dr. De Stefano and colleagues created a definite diagnosis of newonset epilepsy for 501 patients (49.6%). The sensitivity of LT-EEG was greater than that of routine EEG (54.39% vs 25.5%), and the sensitivity of MRI was higher than that of CT (67.98% vs 54.72%). Consideration of only MRI and LT-EEG would have resulted in five incorrect diagnoses of nonepileptic causes when compared with routine EEG and MRI (P<0.001).
