eMedicine Specialties > Neurology > Seizures and Epilepsy
Simple Partial Seizures: Differential Diagnoses & Workup
Updated: Sep 3, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Atypical facial pain
Benign epilepsy syndromes
Brainstem syndromes
Carcinoid syndrome
Cardiac disorders
Cervical disk syndromes
Gastrointestinal disorders
Hypoglycemic episodes
Transient ischemic attacks (TIAs)
Migraines
Myoclonus
Panic attacks
Psychosis
Workup
Laboratory Studies
- Electrolytes including serum glucose
- Thyroid-stimulating hormone and/or thyroid profile
- Toxin and drug screen
Imaging Studies
CT scan of the brain, with and without contrast, is primarily useful and appropriate in an emergency setting or for patients unable to have MRI studies. Coronal T2-weighted MRI with fluid-attenuated inversion recovery (FLAIR) and careful attention to the mesial temporal structures is more likely to demonstrate abnormalities if a diagnosis of SPS already has been established. Low resolution MRI, under 1.5 T, should be discouraged in any evaluation of epilepsy. This typically makes the use of "open MRI" inadequate.
Other Tests
- Electroencephalography
- EEGs fortuitously obtained during the patient's symptoms can provide clear support for a diagnosis.
- EEGs obtained soon after a suspected seizure often record nonspecific patterns or may be normal.
- Activation by sleep deprivation, photic stimulation, and/or hyperventilation increases the ability to detect abnormalities on a single recording. Repeat or prolonged recording may increase the chance of recording interictal or ictal patterns of diagnostic significance.
- Although interictal spikes in an appropriate anatomical location for the symptoms of the suspected seizure are highly suggestive of epilepsy, they may be distant in location from the actual area of seizure onset, giving poor localizing information for possible epilepsy surgery.
- Single or rare interictal sharp waves may be normal variants, and further diagnostic confirmation should be pursued.
- Normal EEG findings do not exclude the possibility of epilepsy.
- Video-EEG
- Video-EEG is often necessary to record typical clinical events and to correlate them with any electrographic changes.
- Many SPS are characterized by EEG patterns that are difficult to record, and the diagnosis may depend entirely on video analysis of reproducible ictal semiology of multiple events, or on observation by trained personnel.
- EEG performed with extra scalp electrodes or intracranial electrodes is necessary if involvement of mesial structures is suspected.
- Routine 12-lead ECG and a rhythm strip should be obtained in all subjects with cardiac, thoracic, gastrointestinal, or focal positive and negative sensations.
- Twenty-four–hour Holter monitoring and inpatient telemetry are appropriate if daily episodes are expected (based on history).
- A telephone transmittal cardiac recorder can be useful for episodes occurring infrequently.
Procedures
- Lumbar puncture should be performed in all cases of suspected meningitis, unless neuroimaging or funduscopic examination suggests increased intracranial pressure.
- Brain biopsy is strongly suggested to confirm the diagnosis in suspected cases of Rasmussen encephalitis, or in focal progressive lesions of unknown etiology.
Histologic Findings
- Various microscopic abnormalities, including the following, can be found in the epileptogenic zone:
- Focal cortical dysplasia
- Hippocampal sclerosis
- Neoplasia
- Cortical inflammation
- Encephalomalacia
- Vascular malformation
More on Simple Partial Seizures |
| Overview: Simple Partial Seizures |
 Differential Diagnoses & Workup: Simple Partial Seizures |
| Treatment & Medication: Simple Partial Seizures |
| Follow-up: Simple Partial Seizures |
| References |
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References
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Further Reading
Keywords
focal seizures, simple localization-related epilepsy, SPS, epilepsy, simple partial status epilepticus, SPSE, epilepsia partialis continua, Kojewnikoff syndrome, periodic lateralized epileptiform discharges, PLEDs, Landau-Kleffner syndromes, epileptogenic zone, partial seizures, simple partial seizures
