An Outcome Study of Referrals to the Epilepsy Clinic at the Montreal Neurological Institute (MNI) (P1.088)
Bibliographic record
Abstract
Objective: Determine the characteristics of patients assessed at our tertiary care epilepsy clinic who had a final diagnosis other than epilepsy. Background: The incidence and clinical characteristics of patients with other disorders causing paroxystic symptoms that could be misdiagnosed as seizures has not yet been determined. Methods: This study has been approved by the MNI Research Ethics Board. We retrospectively analyzed charts from patients referred from Jan2013-Jan2015. Results: Of 389 new patients evaluated, 25.4[percnt] did not have epilepsy. Most referrals came from the emergency room and family physicians. Clinically, reasons for suspected seizures were: episodes of loss of consciousness (22[percnt]), recurrent motor manifestations (6[percnt]) or recurrent subjective symptoms only (52[percnt]). Mean age at visit was 40 (range 10 to 81), 59 were female, and duration of symptoms was on average 8 years (2 months to 45 years). Prior to the first visit, 58 patients (59[percnt]) had undergone an EEG recording (14 patients (15[percnt]) had a sleep EEG recording) and 31 (32[percnt]) had an MRI. In 80[percnt] of patients, the epileptologist was able to exclude the diagnosis of epilepsy within 2 visits and with minimal additional investigations. Prolonged video-EEG monitoring was required in 20[percnt] of patients. The most common diagnoses were syncope (32[percnt]), psychiatric symptoms (19[percnt]) followed by psychogenic non-epileptic seizures (12[percnt]) and migraine (10[percnt]). Conclusions: A large proportion of patients seen in our tertiary care epilepsy clinic did not have a final diagnosis of epilepsy. Most often, seizures could be ruled out after one additional follow-up visit and with minimal additional exams. Developing guidelines to assist referring physicians to safely triage these patients through detailed interview and to optimally use paraclinical investigations could shorten the time required to arrive at a proper diagnosis. Enhanced knowledge about these patients can also help us improve guidelines and continuous education programs targeting non-specialists.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".