Temporal Lobe Epilepsy Differential Diagnoses

  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Mar 12, 2012
 
 

Diagnostic Considerations

Panic disorder

This may be associated with autonomic phenomena and anxiety similar to those observed in the simple partial phase of a temporal lobe seizure. However, unlike temporal lobe epilepsy, which lasts seconds to 2 minutes, panic attacks last several minutes (usually >10 min).

Occipital lobe epilepsy

This type of epilepsy may propagate to the temporal lobe and be clinically indistinguishable from a temporal lobe seizure.

Excessive daytime somnolence

This may be due to a sleep-related breathing disorder or narcolepsy. It causes episodes of loss of time due to falling asleep frequently.

Psychogenic seizures

Approximately 10-30% of patients with psychogenic seizures also have epileptic seizures. The diagnosis of psychogenic seizure needs to be made after a thorough evaluation as some seizures that are atypical may be true seizures. The importance of diagnosing nonepileptic seizures is important as psychogenic seizures do not respond to antiepitlepic events and require psychiatric intervention.

Frontal lobe epilepsy

Frontal lobe complex partial seizures have certain distinctive characteristics. They appear in clusters of many brief seizures with rapid onset and ending and minimal, if any, postictal state. Prominent features include bizarre behavioral changes such as vocalizations and complex motor and sexual automatisms. However, distinguishing frontal lobe complex partial seizures from those of the temporal lobe based solely on clinical features may be difficult; EEG is invaluable for localization.

Absence epilepsy

Generalized absence seizures have an abrupt onset with no aura, usually last less than 30 seconds, and have no postictal state. EEG in absence shows generalized, bilaterally synchronous spike-and-wave discharges and photosensitivity. Complex partial seizures usually are preceded by a distinct aura, last longer than a minute, and have a period of postictal confusion. EEG shows focal spikes in complex partial seizures.

Other considerations

Epilepsy occurs in all age groups, but it has been underrecognized in elderly persons. Epilepsy in elderly persons may not be as dramatic and often may present as confusion or memory lapses. The index for suspicion should be low, as patients are often misdiagnosed and not treated appropriately.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

David Y Ko, MD  Associate Professor of Clinical Neurology, Associate Director, USC Adult Epilepsy Program, Keck School of Medicine of the University of Southern California

David Y Ko, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Headache Society

Disclosure: GSK Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching; Lundbeck Consulting fee Consulting; Westward Consulting fee Consulting

Coauthor(s)

Soma Sahai-Srivastava, MD  Director of Neurology Ambulatory Care Services, LAC and USC Medical Center; Assistant Professor, Department of Neurology, Keck School of Medicine of the University of Southern California

Soma Sahai-Srivastava, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Additional Contributors

Jose E Cavazos, MD, PhD, FAAN Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director of the San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association

Disclosure: GXC Global, Inc. Intellectual property rights Medical Director - company is to develop a seizure detecting device. No conflict with any of the eMedicine articles that I wrote or edited.

Erasmo A Passaro, MD, FAAN Director, Comprehensive Epilepsy Program/Clinical Neurophysiology Lab, Bayfront Medical Center, Florida Center for Neurology

Erasmo A Passaro, MD, FAAN is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association, and American Society of Neuroimaging

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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  2. Berkovic SF, McIntosh A, Howell RA, Mitchell A, Sheffield LJ, Hopper JL. Familial temporal lobe epilepsy: a common disorder identified in twins. Ann Neurol. Aug 1996;40(2):227-35. [Medline].

  3. Acharya V, Acharya J, Lüders H. Olfactory epileptic auras. Neurology. Jul 1998;51(1):56-61. [Medline].

  4. Engel J Jr, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S, et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. Mar 7 2012;307(9):922-30. [Medline].

  5. Semah F, Picot MC, Adam C, Broglin D, Arzimanoglou A, Bazin B, et al. Is the underlying cause of epilepsy a major prognostic factor for recurrence?. Neurology. Nov 1998;51(5):1256-62. [Medline].

  6. Foldvary N, Nashold B, Mascha E, Thompson EA, Lee N, McNamara JO, et al. Seizure outcome after temporal lobectomy for temporal lobe epilepsy: a Kaplan-Meier survival analysis. Neurology. Feb 8 2000;54(3):630-4. [Medline].

 
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