Suffering and Medical Guidelines Treatment Analysis of 252 Patients First Seen at the Outpatient Unit of an Epilepsy Clinic

We have re-evaluated the quality of diagnosis and therapy in 252 patients (153 women, 99 men; median age 36 years) seen in 2009 at the outpatient department of the Clinic of Epileptology, Bonn. All patients were seen by the same specialist. 164 patients (65.1 %) suffered from epilepsy, in 61 (24.2 %) epilepsy was the most probable diagnosis, 27 (10.2 %) suffered from psychogenic seizures. The analysis showed that in 130 patients (51.6 %) an examination by a specialist was reasonable because of the complex treatment or diagnostic situations. In another 55 patients (21.8 %) a second opinion was quite reproducible because of the lack of guideline recommendations. In 67 patients (26.6 %) the examination by a specialist was not reproducible because of the guidelines for the individual treatment or diagnostic procedure on hand. Most management problems were diagnosis of epilepsy or psychogenic seizures, choice of a first antiepileptic monotherapy and treatment after failure of monotherapy. Treatment of patients with seizures could be improved by strengthening the knowledge of basic diagnostic and therapeutic procedures.