People with epilepsy may suffer substantially. Beyond the danger of seizures themselves, and the elevated risk of sudden death, these folks have a higher risk of behavioral and cognitive disorders, are more likely than people without epilepsy to be impoverished and jobless, and continue to be affected by stigma and misunderstandings.

All of that is precisely why correct diagnosis is important. And somewhere between 16.3–23% of cases in two good studies had at least a questionable diagnosis, if not a definite alternative (review here). One of those studies showed that in 49 patients diagnosed with epilepsy 15 actually had a cardiovascular cause. An earlier review of the literature estimated 2–71% misdiagnosis rate—a laughably broad estimate reflecting different populations being tested.

The literature also reflects problems with EEG interpretation. Benbadis in an earlier article wrote “By far the most common patterns overread as epileptiform are nonspecific fluctuations of background in the temporal regions, which are misread as temporal sharp waves.”

I personally find that clinicians are often surprised how convulsive syncope can be and how long syncope can last. Lin et al. documented a high incidence of convulsive syncope among blood donors. The semiology varied; most commonly “tonic extensor spasm” but also including myoclonus, clonic movements. In this review it’s noted that, although absolute loss of awareness typically lasts less than a minute in syncope, it “may take several minutes to fully regain consciousness” and may be followed by “occasionally quite prolonged” fatigue.