Personal practice Pitfalls in the management of epilepsy G STORES National Centre for Children with Epilepsy and Regional Paediatric EEG Unit, Park Hospital for Children,

Recent publications on childhood epilepsy and personal experience at the National Centre for Children with Epilepsy both suggest that the man-agement of children with this disorder remains an area of clinical practice in which special difficulties are encountered. The following remarks are rel-evant mainly for children of school age. Emergency situations are not considered. Differential diagnosis Different types of attack may be superficially similar and confusion between epileptic and non-epileptic attacks may well occur. It seems that various types of non-epileptic attack continue to be misdiagnosed as epilepsy. In one recent series a quarter of patients referred to an epilepsy clinic had been misdiagosed in this way. 1 Faints and breathholding attacks, especially those that end with convulsive move-ments, were often misconstrued as epilepsy, as were aggressive outbursts, sleep disorders, and atypical forms of migraine. Accurate diagnosis should be possible from a precise description of each attack (from the very first change to full recovery) and from the circum-stances in which the attacks occur as the various types of attack have characteristic features.2 If the true nature of the child's attacks remains obscure, in spite of a precise description, prolonged electro-encephalogram (EEG) recordings during attacks can be helpful.3 Sometimes the opposite problem is en-countered-that is, seizures are not recognised as such and are diagnosed as non-epileptic attacks, usually of a psychological type. This risk is greatest with non-convulsive seizures and is particularly likely to occur if the wide range of seizure types described in the international classification of seizures4 is not appreciated. Seizure type Seizures are often not accurately classified. All non