Improving epilepsy diagnosis across the lifespan: approaches and innovations.

Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.

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Declaration of interests JP has received research support from the Department of Neurology at the University of Colorado School of Medicine, the Colorado Clinical and Translational Sciences Institute, National Institutes of Health and National Institute of Neurological Disorders and Stroke, and the American Epilepsy Society. JP serves as chair of the professional advisory board for the Epilepsy Foundation of Colorado and Wyoming (unpaid), serves as the Epilepsy Section Editor for Current Neurology and Neuroscience Reports, and has received compensation for serving on the scientific advisory board for SK Life Science. ECF declares research support from Brain Foundation (Australia), LivaNova (USA), Lundbeck (Australia), Monash Partners STAR Clinician Fellowship, Sylvia and Charles Viertel Charitable Foundation, and The Royal Australian College of Physicians Fellows Research Establishment Fellowship. SMZ serves as the Neurodevelopmental Theme Lead for the Epilepsy Research Institute UK (unpaid). SMZ's institution has received grants related to epilepsy diagnostics from Epilepsy Research UK, Scottish Government Digital Health & Care, and Amazon Web Services. vCreate has contributed donations to SMZ's institution charity. JMW serves as the Associate Editor for Epilepsia (honorarium) and Developmental Medicine and Child Neurology, chief editor of the Pediatric Neurology sub-section of Frontiers in Neurology (honorarium), and serves on the National South African Advisory board for Novartis and Sanofi. JF receives salary support from the Epilepsy Foundation and for consulting work or attending Scientific Advisory Boards on behalf of the Epilepsy Study Consortium for Aeonian/Aeovian, Alterity Therapeutics, Anavex, Arkin Holdings, Angelini Pharma S.p.A, Arvelle Therapeutics, Athenen Therapeutics/Carnot Pharma, Autifony Therapeutics, Baergic Bio, Biogen, Biohaven Pharmaceuticals, BioMarin Pharmaceutical, BioXcel Therapeutics, Bloom Science, BridgeBio Pharma, Camp4 Therapeutics Corporation, Cerebral Therapeutics, Cerevel, Clinical Education Alliance, Coda Biotherapeutics, Corlieve Therapeutics, Crossject, Eisai, Eliem Therapeutics, Encoded Therapeutics, Engage Therapeutics, Engrail, Epalex, Epihunter, Epiminder, Epitel, Equilibre BioPharmaceuticals, Greenwich Biosciences, Grin Therapeutics, GW Pharma, Janssen Pharmaceutica, Jazz Pharmaceuticals, Knopp Biosciences, Lipocine, LivaNova, Longboard Pharmaceuticals, Lundbeck, Marinus, Mend Neuroscience, Merck, NeuCyte, Neumirna Therapeutics, Neurocrine, Neuroelectrics USA Corporation, Neuronetics, Neuropace, NxGen Medicine, Ono Pharmaceutical, Otsuka Pharmaceutical Development, Ovid Therapeutics, Paladin Labs, Passage Bio, Pfizer, Praxis, PureTech LTY, Rafa Laboratories, SK Life Sciences, Sofinnova, Stoke, Supernus, Synergia Medical, Takeda, UCB, Ventus Therapeutics, Xenon, Xeris, Zogenix, and Zynerba. JF has also received research support from the Epilepsy Study Consortium (funded by Andrews Foundation, Eisai, Engage, Lundbeck, Pfizer, SK Life Science, Sunovion, UCB, Vogelstein Foundation), Epilepsy Study Consortium/Epilepsy Foundation (funded by UCB), GW/FACES, and NINDS. JF is on the editorial board of The Lancet Neurology and Neurology Today. JF is Chief Medical/Innovation Officer for the Epilepsy Foundation. JF has received travel reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, Angelini Pharma S.p.A., Clinical Education Alliance, NeuCyte, Neurocrine, Praxis, and Xenon.