Editing Epilepsy (section)

===Differential diagnosis===
A number of conditions can resemble epileptic seizures, leading to potential misdiagnosis. Accurate diagnosis is essential, as inappropriate treatment may delay effective care or cause harm. Common mimics include [[Syncope (medicine)|fainting]] (syncope), [[psychogenic non-epileptic seizures]] (PNES), [[Transient ischemic attack|transient ischemic attacks]], [[migraine]], [[narcolepsy]], and various sleep or movement disorders.<ref>{{cite journal |vauthors=Brodtkorb E |year=2013 |title=Common imitators of epilepsy |journal=Acta Neurologica Scandinavica. Supplementum |volume=127 |issue=196 |pages=5–10 |doi=10.1111/ane.12043 |pmid=23190285 |doi-access=free}}</ref><ref name="Rosen2010">{{cite book |url=https://books.google.com/books?id=u7TNcpCeqx8C&pg=PA2228 |title=Rosen's emergency medicine: concepts and clinical practice |publisher=Mosby/Elsevier |year=2010 |isbn=978-0-323-05472-0 |veditors=Marx JA |edition=7th |location=Philadelphia |page=2228}}</ref> In children, [[Gastroesophageal reflux disease|reflux]], breath-holding spells, and parasomnias such as night terrors may also resemble seizures.<ref name="Rosen2010" />

Psychogenic non-epileptic seizures (PNES) are a particularly important consideration, especially in individuals with refractory epilepsy. PNES are involuntary episodes that resemble epileptic seizures but are not associated with abnormal electrical discharges. They are classified as functional neurological disorders and are typically associated with psychological distress or trauma. Studies suggest that approximately 20% of individuals referred to epilepsy centers are diagnosed with PNES,<ref name="AFP2012" /> and up to 10% of these individuals also have coexisting epilepsy.<ref name="Jer2013">{{cite book |url=https://books.google.com/books?id=5PgjmjugIX8C&pg=PA462 |title=Seizures and epilepsy |vauthors=Jerome E |publisher=Oxford University Press |year=2013 |isbn=978-0-19-532854-7 |edition=2nd |location=New York |page=462}}</ref> Differentiating between the two can be difficult and often requires prolonged video EEG monitoring.<ref name="Jer2013" />

Misdiagnosis remains a significant concern in epilepsy. Reported rates vary widely — from 2% to 71% — depending on factors such as clinical setting, patient population, diagnostic criteria, and physician expertise.<ref>{{Cite journal |last=Oto |first=Maria (Meritxell) |date=2017-01-01 |title=The misdiagnosis of epilepsy: Appraising risks and managing uncertainty |url=https://www.sciencedirect.com/science/article/pii/S1059131116302977 |journal=Seizure |series=25th Anniversary Issue |volume=44 |pages=143–146 |doi=10.1016/j.seizure.2016.11.029 |issn=1059-1311}}</ref><ref>{{Cite journal |last=Xu |first=Ying |last2=Nguyen |first2=Dennis |last3=Mohamed |first3=Armin |last4=Carcel |first4=Cheryl |last5=Li |first5=Qiang |last6=Kutlubaev |first6=Mansur A. |last7=Anderson |first7=Craig S. |last8=Hackett |first8=Maree L. |date=2016-10-01 |title=Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies |url=https://www.seizure-journal.com/article/S1059-1311(16)30133-9/fulltext |journal=Seizure - European Journal of Epilepsy |language=English |volume=41 |pages=167–174 |doi=10.1016/j.seizure.2016.08.005 |issn=1059-1311 |pmid=27592470}}</ref> While epilepsy can be mistakenly diagnosed in individuals with other conditions, the opposite can also occur: certain forms of epilepsy, particularly those with subtle or nocturnal symptoms,<ref>{{Cite journal |last=Miano |first=Silvia |last2=Peraita-Adrados |first2=Rosa |date=2013-03-01 |title=[Nocturnal frontal lobe epilepsy is often misdiagnosed as sleep disorders in children: a case series] |url=https://pubmed.ncbi.nlm.nih.gov/23440753 |journal=Revista De Neurologia |volume=56 |issue=5 |pages=257–267 |issn=1576-6578 |pmid=23440753}}</ref> may be mistaken for behavioral or psychological disorders. Delays in diagnosis can lead to prolonged morbidity and inappropriate treatment, highlighting the importance of careful clinical assessment and appropriate use of EEG and video documentation.