Understanding Seizure Disorder Misdiagnosis in New York
Seizure disorders affect millions of Americans, yet studies reveal a troubling reality: between 20% and 30% of people diagnosed with epilepsy have been misdiagnosed [Source: NIH – Preventing Misdiagnosis of Epilepsy, 2007]. When healthcare providers fail to accurately diagnose seizure-like symptoms, patients can face years of unnecessary treatment, dangerous medication side effects, and potentially life-threatening delays in receiving proper care for their actual medical conditions.
In New York, seizure disorder misdiagnosis represents a serious form of diagnostic error that can lead to significant medical malpractice claims. If you or a loved one has suffered harm due to an incorrect seizure diagnosis, understanding your legal rights is essential.
Key Takeaways
- Misdiagnosis rates are alarmingly high: 20-30% of epilepsy diagnoses prove incorrect upon specialist review
- Common causes include: EEG over-interpretation, inadequate history-taking, and confusion with cardiovascular syncope
- Consequences can be severe: Unnecessary medications, driving restrictions, employment problems, and missed treatment for actual conditions
- New York law provides protections: 2.5-year statute of limitations with specific exceptions for continuous treatment
- Legal action requires proof: Medical standard of care breach, causation, and resulting damages
The Scope of Seizure Disorder Misdiagnosis
Alarming Statistics from Medical Research
Medical literature consistently documents concerning rates of seizure disorder misdiagnosis across multiple healthcare settings:
Adult Patients
26% misdiagnosis rate among patients referred to specialist neurologists for “refractory epilepsy” – meaning one in four patients treated for treatment-resistant seizures didn’t actually have epilepsy [Source: BMJ – The Misdiagnosis of Epilepsy, 1999].
Pediatric Patients
31.8% misdiagnosis rate documented in a British Paediatric Neurology Association review, leading to a £10 million legal settlement [Source: NIH, 2007].
Tertiary Referrals
39% of patients referred to Denmark’s specialized Epilepsy Centre did not actually have epilepsy despite prior diagnoses [Source: NIH, 2007].
PNES Misdiagnosis
75% of patients with psychogenic non-epileptic seizures (PNES) are initially told they have epilepsy, taking years to correct [Source: Epilepsy Foundation].
Research published in medical journals reveals that up to 30% of adults diagnosed with epilepsy who don’t respond to medication actually have a different condition [Source: Expert Review of Neurotherapeutics, 2009]. These statistics demonstrate a systemic problem in seizure disorder diagnosis that affects thousands of patients nationwide.
The Financial and Personal Cost
In the United Kingdom, researchers estimated the total cost of epilepsy misdiagnosis at approximately £125 million annually, accounting for unnecessary outpatient visits, investigations, and medications [Source: BMJ, 1999]. While comparable U.S. figures aren’t readily available, the economic burden is likely substantially higher given our larger population and healthcare costs.
Common Causes of Seizure Disorder Misdiagnosis
1. EEG Over-Interpretation and Misreading
Electroencephalogram (EEG) misinterpretation represents one of the most significant contributors to seizure disorder misdiagnosis. A major problem is the tendency to over-read normal tracings as abnormal, with diagnoses sometimes based solely on a supposedly “abnormal” EEG [Source: Expert Review of Neurotherapeutics, 2009].
Critical EEG Limitations
Sensitivity: Only 40-50% of children with confirmed epilepsy show epileptiform abnormalities on a single interictal EEG.
Specificity: Up to 3.5% of children without epilepsy display epileptiform abnormalities on interictal EEG [Source: NIH, 2007].
Why EEG misinterpretation occurs:
- Inadequate training: Neurologists can become fully certified with minimal or no EEG experience, as the Accreditation Council for Graduate Medical Education (ACGME) has no specific EEG requirement
- Normal variations misidentified: Developmental changes in normal EEGs, background abnormalities, and “non-epileptogenic epileptiform” patterns are erroneously used to support epilepsy diagnoses
- Inexperience with normal ranges: Less experienced readers apply lower thresholds for “abnormality,” seeing problems where none exist
- Over-reliance on technology: Physicians may trust EEG results over clinical history, even when the patient’s symptoms don’t suggest seizures
2. Inadequate Clinical History Taking
Research identifies incomplete history taking as the primary reason for misdiagnosis in multiple studies [Source: NIH, 2007]. Seizure and epilepsy diagnosis relies heavily on patient and witness accounts, yet many healthcare providers fail to gather comprehensive information about:
- Exact sequence of events before, during, and after episodes
- Triggers or precipitating factors
- Witness observations of the patient’s behavior
- Duration and frequency of episodes
- Associated symptoms (palpitations, lightheadedness, aura)
- Family history of seizures or cardiovascular conditions
- Circumstances surrounding episodes (standing, emotional stress, specific activities)
Home video recordings of episodes can provide invaluable diagnostic information, yet many physicians fail to request this readily available evidence.
3. Conditions Commonly Mistaken for Seizure Disorders
A comprehensive study of 442 children referred with suspected epilepsy revealed the actual diagnoses of those who did not have seizure disorders [Source: NIH, 2007]:
| Actual Diagnosis | Percentage of Misdiagnosed Cases |
|---|---|
| Syncope (various types) | 42% |
| Psychological non-epileptic events | 8% |
| Daydreaming | 5% |
| Night terrors | 4% |
| Migraine | 3% |
| Benign paroxysmal vertigo | 2% |
| Other paroxysmal disorders | 8% |
| Undiagnosed | 14% |
Cardiovascular Syncope: The Leading Mimic
Cardiovascular conditions cause many seizure-like episodes. Research shows that when syncope was deliberately induced in healthy volunteers, 90% experienced myoclonus (muscle jerking), usually multifocal [Source: BMJ, 1999]. This creates diagnostic confusion, as muscle jerking is commonly associated with epileptic seizures.
One study found that 31% of patients with continued “seizures” despite antiepileptic drugs actually had treatable cardiovascular conditions [Source: BMJ, 1999], including:
- Prolonged QT syndrome
- Vasovagal syncope
- Cardiac arrhythmias
- Orthostatic hypotension
Psychogenic Non-Epileptic Seizures (PNES)
PNES, also called functional seizures or dissociative seizures, resemble epileptic seizures but are not caused by abnormal electrical brain activity. Instead, they represent a functional neurological disorder with psychiatric origins, often classified as conversion disorder [Source: StatPearls – PNES, 2024].
Critical facts about PNES misdiagnosis:
- 25% of patients with prior epilepsy diagnoses who don’t respond to medication actually have PNES
- 30-50% of PNES patients have been incorrectly admitted to intensive care with a diagnosis of status epilepticus
- 10-30% of PNES patients also have comorbid epilepsy, complicating diagnosis
- Average diagnostic delay: 7-10 years, during which patients receive inappropriate antiepileptic medications
4. Acute Symptomatic Seizures vs. Epilepsy
Not all seizures indicate epilepsy. A population-based study in Rochester, Minnesota found that 40% of incident seizures are symptomatic of acute systemic or cerebral disturbances rather than epilepsy [Source: BMJ, 1999]. Common causes include:
- Fever in children (febrile seizures)
- Alcohol withdrawal in adults
- Metabolic disturbances (hypoglycemia, electrolyte imbalances)
- Head trauma
- Infections (meningitis, encephalitis)
- Drug toxicity or interactions
Misdiagnosing these acute symptomatic seizures as epilepsy leads to unnecessary long-term antiepileptic drug therapy while potentially missing treatable underlying conditions.
Serious Consequences of Seizure Disorder Misdiagnosis
Medical Harms
Unnecessary medication exposure: Antiepileptic drugs carry significant side effects, including cognitive impairment, mood changes, liver damage, bone density loss, and birth defects. One study documented that 19 misdiagnosed patients experienced side effects from unnecessary drugs [Source: BMJ, 1999].
Delayed treatment for actual conditions: When seizure-like symptoms stem from cardiovascular disease, psychiatric disorders, or other medical conditions, misdiagnosis as epilepsy prevents patients from receiving appropriate treatment. Life-threatening conditions like prolonged QT syndrome and hyperekplexia can be missed entirely.
ICU admissions and aggressive interventions: PNES patients misdiagnosed with status epilepticus receive massive doses of anti-seizure medications until impaired consciousness or respiratory failure occurs, sometimes requiring unnecessary endotracheal intubation with iatrogenic complications [Source: StatPearls, 2024].
Social and Economic Consequences
An incorrect epilepsy diagnosis triggers severe restrictions and limitations:
Driving Restrictions
New York law prohibits people with uncontrolled seizures from driving. Research found 12 misdiagnosed patients had unnecessary driving restrictions, severely limiting independence and employment options [Source: BMJ, 1999].
Employment Problems
Epilepsy diagnoses can disqualify individuals from certain occupations and professional licenses. The same study documented serious employment problems in 5 patients, with 3 dependent on state benefits due to misdiagnosis.
Educational Impact
Educational expectations are often lowered for children diagnosed with epilepsy, potentially limiting their academic achievement and future career prospects when the diagnosis is incorrect.
Psychological Burden
Living with an epilepsy diagnosis carries stigma, anxiety about having seizures in public, and restrictions on activities like swimming. These psychological burdens become particularly tragic when imposed unnecessarily.
Mortality Risks
The National Sentinel Audit of epilepsy-related child deaths found that 77% showed inadequacies in care, with 59% considered possibly or potentially avoidable [Source: NIH, 2007]. While not all involve misdiagnosis, the data highlights serious systemic problems in seizure disorder management.
Medical Standard of Care for Seizure Diagnosis
Best Practices to Prevent Misdiagnosis
Medical guidelines emphasize several critical elements for accurate seizure disorder diagnosis:
1. Comprehensive Clinical History
The diagnosis should primarily rely on detailed history from the patient and witnesses, not solely on EEG findings. Physicians should:
- Conduct extended interviews with patients and witnesses
- Request home video recordings of episodes
- Document precise timing, triggers, and circumstances
- Investigate family history thoroughly
- Assess for cardiovascular and psychiatric risk factors
2. Appropriate Use of Diagnostic Testing
EEG limitations must be acknowledged: A normal EEG does not exclude epilepsy (sensitivity less than 50%), and abnormalities can occur in healthy individuals [Source: Medscape – First Adult Seizure Workup].
Video-EEG monitoring: When diagnosis remains uncertain, video-EEG telemetry should be performed to capture events with simultaneous clinical and electrical recording. This is particularly important for:
- Suspected PNES
- Treatment-resistant “epilepsy”
- Atypical presentations
- Diagnostic uncertainty after routine evaluation
3. Specialist Involvement
NICE guidelines recommend that epilepsy diagnosis in children should be made by a specialist defined as “a paediatrician with training and expertise in the epilepsies” [Source: NIH, 2007]. Similar standards should apply to adult diagnosis.
Qualified specialists should have:
- Formal training and continuing education in epilepsy
- Regular diagnostic audits and peer review
- Minimum one session weekly devoted to epilepsy
- Access to video-EEG monitoring and neuroimaging
- Participation in managed clinical networks
4. Pursuit of Syndromic Diagnosis
Rather than simply diagnosing “epilepsy,” specialists should attempt to identify the specific epilepsy syndrome, which provides prognostic information and guides treatment. Research shows that specific syndrome diagnosis is achievable in approximately 48% of cases [Source: NIH, 2007].
5. Considering Differential Diagnoses
NICE guidelines list 36 possible alternative diagnoses for seizure-like symptoms [Source: NIH, 2007]. Physicians must systematically evaluate cardiovascular, psychiatric, metabolic, and other neurological conditions before confirming epilepsy.
When Misdiagnosis Constitutes Medical Malpractice
Not every diagnostic error constitutes malpractice. New York law requires proof of several elements:
Elements of Medical Malpractice in New York
- Doctor-patient relationship: A treatment relationship existed
- Deviation from standard of care: The physician’s diagnostic approach fell below what competent physicians would do under similar circumstances
- Causation: The misdiagnosis directly caused harm
- Damages: The patient suffered quantifiable injuries and losses
Examples of actions that may constitute malpractice include:
- Diagnosing epilepsy based solely on over-read EEG without adequate clinical correlation
- Failing to take comprehensive history from patient and witnesses
- Not considering obvious alternative diagnoses (cardiovascular syncope in patient with cardiac risk factors)
- Failing to refer to appropriate specialists when diagnosis is uncertain
- Not ordering video-EEG monitoring when indicated for treatment-resistant “epilepsy”
- Continuing epilepsy diagnosis without reassessment when patient doesn’t respond to multiple medications
- Missing life-threatening conditions (prolonged QT syndrome, cardiac arrhythmias) by prematurely concluding epilepsy
New York Legal Considerations for Seizure Misdiagnosis Claims
Statute of Limitations
New York’s medical malpractice statute of limitations is generally 2.5 years from the date of the misdiagnosis or from the last treatment under the continuous treatment doctrine [Source: Fuchsberg Law Firm].
Standard Deadline
Two years and six months from the date of the alleged malpractice to file a lawsuit [Source: NY CPLR § 214-A].
Continuous Treatment
The statute of limitations doesn’t begin while the patient receives ongoing treatment for the same condition from the same provider, recognizing patient reliance on the physician’s judgment [Source: Pagan Law Firm].
Municipal Hospitals
Claims against government-run facilities require filing a notice of claim within 90 days, followed by a lawsuit within 15 months [Source: Pagan Law Firm].
Minors
For children, the statute is tolled until age 18, but lawsuits cannot be filed more than 10 years from the negligent act [Source: Pagan Law Firm].
Important: Lavern’s Law, which extends deadlines for cancer misdiagnosis, does not apply to seizure disorder misdiagnosis. Standard timing rules apply.
Recoverable Damages in Seizure Misdiagnosis Cases
Victims of seizure disorder misdiagnosis in New York may recover compensation for:
Economic Damages
- Medical expenses: Cost of unnecessary antiepileptic medications, EEG tests, neurologist visits, and ER visits for misdiagnosed conditions
- Future medical costs: Treatment needed for actual underlying condition that was missed, including cardiac procedures, psychiatric care, or treatment for permanent injuries
- Lost wages: Income lost due to inability to work because of misdiagnosis-related restrictions or complications
- Lost earning capacity: Reduced future income potential due to educational limitations, professional license restrictions, or permanent disabilities caused by delayed diagnosis
Non-Economic Damages
- Pain and suffering: Physical discomfort from unnecessary medications or procedures
- Emotional distress: Anxiety, depression, and psychological harm from living with incorrect epilepsy diagnosis
- Loss of enjoyment of life: Restricted activities, inability to drive, stigma, and lifestyle limitations imposed by misdiagnosis
- Loss of consortium: Impact on relationships with spouse and family members
Building a Strong Misdiagnosis Case
Successful seizure misdiagnosis claims typically require:
- Expert medical testimony: A qualified neurologist or epileptologist must testify that the defendant physician’s diagnostic approach fell below accepted standards
- Medical records: Complete documentation of the diagnostic workup, EEG interpretations, treatment history, and eventual correct diagnosis
- Evidence of harm: Documentation of medication side effects, lost wages, employment consequences, psychological treatment, or injuries from delayed diagnosis of actual condition
- Causation evidence: Clear connection showing that the misdiagnosis directly caused the damages claimed
Frequently Asked Questions About Seizure Disorder Misdiagnosis
How common is seizure disorder misdiagnosis?
Studies show that 20-30% of people diagnosed with epilepsy are actually misdiagnosed. In specialized epilepsy centers, approximately 25-30% of patients referred for treatment-resistant epilepsy are found not to have epilepsy at all. This makes seizure disorder misdiagnosis one of the most common diagnostic errors in neurology.
What conditions are most often mistaken for seizure disorders?
The most common conditions misdiagnosed as seizure disorders include: cardiovascular syncope (fainting) accounting for 42% of misdiagnoses, psychogenic non-epileptic seizures (PNES) at 8%, daydreaming at 5%, night terrors, migraines, and various other paroxysmal disorders. Cardiovascular conditions are particularly problematic because syncope can cause muscle jerking that resembles seizures.
Can a normal EEG rule out epilepsy?
No. A normal EEG cannot rule out epilepsy because the test has less than 50% sensitivity. Only 40-50% of people with confirmed epilepsy show epileptiform abnormalities on a single routine EEG. Conversely, up to 3.5% of people without epilepsy may have epileptiform abnormalities on EEG. Diagnosis should primarily rely on clinical history, not EEG findings alone.
What are the consequences of being misdiagnosed with epilepsy?
Consequences include: unnecessary exposure to antiepileptic medications with significant side effects (cognitive impairment, mood changes, liver damage), driving restrictions that limit independence and employment, professional license limitations, lowered educational expectations, psychological burden and stigma, delayed treatment for the actual underlying condition (which may be life-threatening), and substantial financial costs from inappropriate treatment.
How long do I have to file a medical malpractice claim in New York?
New York’s statute of limitations for medical malpractice is generally 2.5 years (two years and six months) from the date of the alleged malpractice. However, the continuous treatment doctrine may extend this deadline if you remained under the same physician’s care for the same condition. Claims against municipal hospitals have stricter deadlines: you must file a notice of claim within 90 days.
What is psychogenic non-epileptic seizure (PNES)?
PNES, also called functional seizures, are episodes that resemble epileptic seizures but are not caused by abnormal electrical brain activity. They are psychiatric in origin, often classified as conversion disorder, and typically arise from underlying psychological stress or trauma. PNES affects an estimated 20-30% of people diagnosed with “epilepsy” who don’t respond to medication. Diagnosis requires video-EEG monitoring showing clinical events without accompanying epileptiform activity.
Does every seizure misdiagnosis constitute medical malpractice?
No. Medical malpractice requires proof that the physician’s diagnostic approach fell below the accepted standard of care and that this deviation directly caused harm. Some diagnostic errors occur despite reasonable care because epilepsy diagnosis is inherently challenging. However, common malpractice scenarios include: diagnosing epilepsy based solely on an over-read EEG without adequate clinical history, failing to consider obvious alternative diagnoses, not referring to appropriate specialists when uncertain, or continuing an epilepsy diagnosis without reassessment when multiple medications fail.
How is seizure disorder misdiagnosis proven in court?
Proving misdiagnosis requires: (1) establishing that a doctor-patient relationship existed, (2) demonstrating through expert medical testimony that the physician’s diagnostic approach deviated from accepted standards of care, (3) showing that the misdiagnosis directly caused harm, and (4) documenting quantifiable damages such as medical expenses, lost wages, medication side effects, or delayed treatment for the actual condition. Medical records, EEG interpretations, and treatment history are critical evidence.
What should I do if I suspect I’ve been misdiagnosed with a seizure disorder?
First, seek a second opinion from a board-certified neurologist or epileptologist, preferably at an epilepsy center with video-EEG monitoring capabilities. Request copies of all your medical records, including EEG reports and diagnostic test results. If the second opinion confirms misdiagnosis, consult with a qualified New York medical malpractice attorney to discuss your legal options. Continue any prescribed medications until directed otherwise by a qualified specialist, as stopping antiepileptic drugs suddenly can be dangerous.
Connect with Qualified New York Medical Malpractice Attorneys
If you or a loved one has suffered harm due to seizure disorder misdiagnosis in New York, understanding your legal rights is the first step toward justice and compensation. Medical malpractice cases involving diagnostic errors are complex and require attorneys with specific expertise in both medical and legal aspects of these claims.
At Brain Injury Lawyer New York, we maintain a network of qualified medical malpractice attorneys throughout New York State who have successfully handled misdiagnosis cases. Our affiliated attorneys understand the medical literature on seizure disorder misdiagnosis, work with leading medical experts, and have secured substantial settlements and verdicts for clients harmed by diagnostic errors.
Free Case Evaluation
Connect with experienced New York medical malpractice attorneys who can review your seizure misdiagnosis case at no cost. Our network includes lawyers who:
- Work on contingency fee basis (no upfront costs)
- Have access to leading neurologist expert witnesses
- Understand New York’s medical malpractice laws and deadlines
- Have secured millions in compensation for diagnostic error victims
Time is limited under New York law. Contact us today to discuss your case.
Related Resources
Learn more about diagnostic errors and medical malpractice in New York:
- Stroke Misdiagnosis Lawsuits in New York
- Brain Tumor Misdiagnosis Claims in New York
- NY Medical Malpractice Statute of Limitations Guide
- Average Brain Injury Settlements in New York
Disclaimer: This article provides general information about seizure disorder misdiagnosis and New York medical malpractice law. It does not constitute legal advice, and no attorney-client relationship is created by reading this content. Every case is unique and requires individual evaluation by a qualified attorney. If you have specific questions about a potential medical malpractice claim, consult with a licensed New York attorney experienced in this area of law.
References and Sources
- NIH – Preventing Misdiagnosis of Epilepsy (2007): https://pmc.ncbi.nlm.nih.gov/articles/PMC2065943/
- BMJ – The Misdiagnosis of Epilepsy (1999): https://pmc.ncbi.nlm.nih.gov/articles/PMC1122430/
- Expert Review of Neurotherapeutics – EEG Over-reading (2009): https://www.tandfonline.com/doi/full/10.1586/ern.09.157
- StatPearls – Psychogenic Nonepileptic Seizures (2024): https://www.ncbi.nlm.nih.gov/books/NBK441871/
- Epilepsy Foundation – PNES Information: https://www.epilepsy.com/diagnosis/imitators-epilepsy/psychogenic-nonepileptic-seizures
- New York CPLR § 214-A – Statute of Limitations: https://law.justia.com/codes/new-york/cvp/article-2/214-a/
- Fuchsberg Law Firm – Medical Case Limitation Deadlines: https://www.fuchsberg.com/blog/medical-case-limitation-deadlines
- Medscape – First Adult Seizure Workup: https://emedicine.medscape.com/article/1186214-workup
