Remote EEG Interpretation and Expert Second Opinions for Epilepsy Diagnosis

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• Remote EEG Technology for Global Access
• Epilepsy Misdiagnosis Rates and Consequences
• Seizure Classification Importance
• Medication Selection Criteria
• Expert Interpretation Necessity
• Diagnostic Process Improvement
• Full Transcript

Remote EEG Technology for Global Access

Electroencephalogram (EEG) technology now enables digital transmission across global networks. Dr. Tracey Milligan, MD, confirms that patients can complete EEG monitoring in one location while specialists review results remotely. This technological advancement eliminates geographical barriers to epilepsy expertise. Digital EEG storage and internet transmission facilitate seamless consultation between patients and top epileptologists worldwide.

Epilepsy Misdiagnosis Rates and Consequences

Epilepsy misdiagnosis remains alarmingly common, affecting approximately 40% of patients initially diagnosed with seizure disorders. Dr. Tracey Milligan, MD, emphasizes that many patients receive incorrect diagnoses due to non-specialist evaluation. Common alternative conditions include psychogenic non-epileptic seizures, cardiac arrhythmias, vasovagal syncope, and cough syncope. These diagnostic errors lead to inappropriate treatments and delayed proper care.

Seizure Classification Importance

Accurate seizure classification determines treatment success and patient outcomes. Dr. Anton Titov, MD highlights the critical distinction between focal seizures (originating in one brain region) and generalized seizures (involving both hemispheres simultaneously). This differentiation guides subsequent diagnostic testing and therapeutic approaches. Specialized epileptologists possess the expertise to make these crucial distinctions through comprehensive evaluation.

Medication Selection Criteria

Anti-epileptic medication selection depends on multiple precise factors. Dr. Tracey Milligan, MD, explains that correct medication choices require specific seizure type identification, detailed clinical history, and expert EEG interpretation. Specialized medications target particular seizure classifications, making accurate diagnosis essential. Dr. Tracey Milligan, MD, describes a case where a woman received decades of inappropriate focal epilepsy treatment before proper diagnosis revealed generalized epilepsy.

Expert Interpretation Necessity

Epileptologist expertise proves essential for accurate EEG interpretation and diagnosis. While some EEG patterns might be recognizable to non-specialists, many variations require expert analysis. Dr. Tracey Milligan, MD, emphasizes that only epilepsy specialists can guarantee correct EEG interpretation. This specialized skill directly impacts treatment decisions and patient outcomes, as demonstrated by the case where correct diagnosis led to complete seizure freedom.

Diagnostic Process Improvement

Primary care physicians must maintain high suspicion for epilepsy and implement proper referral protocols. Dr. Anton Titov, MD notes that initial evaluations should include specific questioning about seizure events. Physicians should readily refer potential epilepsy cases to specialists rather than attempting management without neurological expertise. This systematic approach ensures patients access appropriate diagnostic resources and specialist care promptly.

Full Transcript

Dr. Anton Titov, MD: EEGs [ElectroEncephaloGram] can be transmitted electronically now. So patients could have an EEG and monitoring done in one part of the world. But one or several epilepsy experts can assess the situation based on the results of the EEG in another part of the world.

Absolutely, an EEG can be transmitted all over the world. EEG can be stored on digital media. It can be sent via the internet or through other means. There is the ability to take that information and to get an expert opinion about it.

When patients after epileptic seizure see primary care physician, they will probably not see an epileptologist. There should be a very high index of suspicion of epilepsy. A physician must ask the correct questions about what happened.

Any physician should very easily refer a patient to the proper epilepsy experts.

Dr. Anton Titov, MD: Only an epilepsy expert can reliably diagnose and find the cause of what is going on with the patient. Correct choice of medication strictly depends on the exact patient’s type of seizures.

Correct choice of medications also depends on a clinical history and EEG information.

Absolutely! Knowing the correct anti-epilepsy medication for a patient can also depend on the EEG interpretation. The EEG interpretation sometimes can be done easily by a non-expert. But there are some variations of EEG that really do require an expert eye.

Dr. Anton Titov, MD: Only an epilepsy expert can guarantee that an EEG is interpreted correctly.

Does an epileptic seizure begin in one specific part of the brain? Or does it involve both sides of the brain at once? That leads us to other specific diagnostic tests and to the correct treatment.

For example, there is a woman who made this box for me. She had been treated for a focal epilepsy her entire life. She actually had a generalized epilepsy. We could tell the difference on EEG. We then changed her treatment.

We used an epilepsy medication that works for generalized epilepsy. She became epileptic seizure-free. She never had an epileptic seizure in her life.

EEG can be transmitted electronically now. Patients could have an EEG and monitoring completed in one part of the world. Then one or several epilepsy experts can review the situation in another part of the world.

Dr. Anton Titov, MD: EEG and other diagnostic tests are sufficient to make the correct epilepsy diagnosis. Epileptic seizure disorders are very complex. Misdiagnosis of epilepsy is common.

Up to 40% of patients diagnosed with “epilepsy” have another cause of their “epileptic seizures”. Psychogenic pseudo-seizures, heart arrhythmia, vasovagal syncope or cough syncope, etc.

An expert second opinion can be obtained remotely. A medical second opinion in epilepsy can establish a precise diagnosis and effective treatment.