Doctor's 32% error rate 'not unusual', says inquiry

By Jeremy Laurance Health Editor
05 February 2003

A consultant paediatrician who mistakenly diagnosed almost one third
of his patients as having epilepsy had an error rate that was "not
unusual", an inquiry has concluded.

The high error rate, revealed by a review of almost 2,000 children
diagnosed with epilepsy at Leicester Royal Infirmary over an 11-year
period, could be similar at other hospitals, the author of the inquiry
said yesterday.

Between 1990 and 2001, Dr Andrew Holton, a consultant paediatrician at
the Royal Infirmary, diagnosed 1,948 children with epilepsy of whom
618 (32 per cent) had their diagnoses changed or recategorised as a
result of the inquiry, the report said. All the misdiagnosed children
were over-treated or given the wrong treatment and many suffered
side-effects from powerful cocktails of drugs. The families of 308
children are suing the University Hospitals NHS Trust, which runs the
infirmary, for compensation.

Richard Newton, the president of the British Paediatric Neurology
Association who led the inquiry, said: "I always worry this might be
repeated elsewhere. There is the potential for that."

Epilepsy affects one in 200 children but is difficult to diagnose
because children can suffer fits for many reasons, including fainting,
migraine and fever, not related to epilepsy. In most hospitals, cases
are diagnosed by a general paediatrician, but specialist expertise in
paediatric neurology is necessary to make an accurate diagnosis.

Only two known studies have been conducted of epilepsy diagnosed by
general paediatricians, one in Copenhagen which found a 39 per cent
error rate and one in Sarajevo where the error rate was 38 per cent.

Dr Newton said Britain faced a severe shortage of paediatric
neurologists. "Over the last 30 years there have been about 50 reviews
of epilepsy whose findings have been published, filed and forgotten. I
am anxious that shouldn't happen again," Dr Newton said. The inquiry
report, published yesterday, confirmed the findings of an interim
investigation in November 2001, which found Dr Holton had diagnosed
epilepsy in children who had suffered any kind of recurrent episode
including behavioural outbursts, headaches or abnormal movements. He
frequently ignored "normal" EEG reports (measuring electrical activity
in the brain) and prescribed excessive doses of drugs.

The parents of Annabelle Appleyard, six, from Market Harborough, said
her condition had dramatically improved since she came off drugs
prescribed by Dr Holton. Her mother, Rosalind, said: "We like her
better now she is not on medication.She is far more lively and has got
more personality. I am not saying it is easier but it is more of the
child we like to see."

A separate review of Dr Holton's behaviour towards parents found he
had adopted the "wrong approach", in some cases misleading them, or
causing unnecessary anxiety.

Peter Reading, chief executive of Leicester Royal Infirmary, said Dr
Holton, who has been suspended since May 2001, would face a
disciplinary tribunal. However, because he had been working alone with
inadequate resources and a high case load, he would not be sacked. The
trust is supporting his request to retrain in another specialty
outside Leicester.

Confusing signs

Other causes of fits which might be misdiagnosed as epilepsy include:

* Fainting
* Fever
* Infantile spasm
* Night terrors
* Migraine
* Behavioural outbursts
* Head injury