Introduction: Diagnosis of epilepsy in some cases can be challenging due to different seizure
types as well as imitators of epilepsy. Misdiagnosis can lead to unnecessary long-term
antiepileptic drug (AED) treatment. Objectives of the study were: (1) to determine the rate of
false-positive diagnosis of epilepsy in children with previously established diagnosis; (2) to
analyze the clinical and electroencephalographic (EEG) features in children with a
misdiagnosed epilepsy; and (3) to determine the most common cause of misdiagnosis of
Patients and Methods: Our research involved a 10-year period and total of 1011 children with
a diagnosis of epilepsy. Patient history and diagnostic work-up (wakefulness and sleep video-
EEG monitoring, neuroimaging, video documentation of seizures if available as well as other
diagnostic tests) were reviewed in detail by two experienced child neurologists. In case of
misdiagnosis of epilepsy, AEDs were discontinued. All patients were followed several years
by regular clinical check-ups and/or telephone interviews.
Results: We identified misdiagnosis of epilepsy in 101 children (9.99%). Leading causes of
false-positive diagnosis of epilepsy were syncopes (27%) and psychogenic attacks (13%) and
others, there were as follows by frequency: tics/stereotypies, benign myoclonus, breath-
holding spells, convulsive seizures but not epilepsy and others. Overinterpretation of EEG
findings was present as the cause of misdiagnosed epilepsy in 37% of patients.
Conclusion: Our study supports the view that misdiagnosis of epilepsy is not rare. There is a
need for a better clinical understanding of different paroxysmal events, imitators of epilepsy,
and avoiding a tendency to overread normal EEGs as abnormal.