More than a quarter of patients diagnosed with epilepsy by doctors in the ED of an Australian hospital in fact had psychogenic non-epileptic seizures (PNES), according to an audit by neurologists.

The misdiagnosis is important because it can lead to iatrogenic harms when patients with PNES are given inappropriate medications and intubated unnecessarily, the authors wrote in Epilepsia.

In the audit, medical records for all 157 presentations (149 patients) to the ED of the Princess Alexandra Hospital in Brisbane from January to March 2018 were examined by two epileptologists and a neurologist with a special interest in functional neurological disorders.

Just six (4%) of the presentations were diagnosed with PNES in the ED while the remainder were diagnosed with epilepsy.