Epilepsy and Seizures Differential Diagnoses

  • Author: Jose E Cavazos, MD, PhD, FAAN; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Dec 2, 2011
 
 

Diagnostic Considerations

The diagnosis of seizures is based on the clinical history. Because many types of seizures are associated with impairment of consciousness, patients are unaware of their occurrence; thus, the history as related by a witness is of high importance.

The clinical diagnosis can be confirmed by abnormalities on the interictal electroencephalogram (EEG), but these abnormalities could be present in otherwise healthy individuals, and their absence does not exclude the diagnosis of epilepsy.

Not all “spells” are seizures. See the Differentials section, below.

Other conditions that should be considered include the following:

  • Syncope (eg, cardiac arrhythmia, vasovagal syncope, dysautonomia)
  • Metabolic conditions (eg, hypoglycemia)
  • Migraine (eg, migrainous aura, migraine equivalent)
  • Vascular conditions (eg, transient ischemic attacks)
  • Sleep disorder (eg, cataplexy, narcolepsy, night terror)
  • Movement disorder (eg, paroxysmal dyskinesia)
  • Gastrointestinal conditions (eg, esophageal reflux in neonates and infants)
  • Psychiatric conditions (eg, conversion, panic attacks, breath-holding spells, malingering, secondary gain)

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

Mark Spitz, MD  Professor, Department of Neurology, University of Colorado Health Sciences Center

Mark Spitz, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society

Disclosure: pfizer Honoraria Speaking and teaching; ucb Honoraria Speaking and teaching; lumdbeck Honoraria Consulting

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

Ramon Diaz-Arrastia, MD, PhD Professor, Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director, North Texas TBI Research Center, Comprehensive Epilepsy Center, Parkland Memorial Hospital

Ramon Diaz-Arrastia, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, New York Academy of Sciences, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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

  1. Fisher RS, van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. Apr 2005;46(4):470-2. [Medline].

  2. Goodkin HP. The founding of the American Epilepsy Society: 1936-1971. Epilepsia. Jan 2007;48(1):15-22. [Medline].

  3. Rho JM, Sankar R, Cavazos JE. Epilepsy: Scientific Foundations of Clinical Practice. New York, NY: Marcel Dekker; 2004.

  4. Houser CR, Esclapez M. Vulnerability and plasticity of the GABA system in the pilocarpine model of spontaneous recurrent seizures. Epilepsy Res. Dec 1996;26(1):207-18. [Medline].

  5. Sloviter RS. Status epilepticus-induced neuronal injury and network reorganization. Epilepsia. 1999;40(suppl 1):S34-9; discussion S40-1. [Medline].

  6. Scharfman HE, Schwartzkroin PA. Protection of dentate hilar cells from prolonged stimulation by intracellular calcium chelation. Science. Oct 13 1989;246(4927):257-60. [Medline].

  7. Cavazos JE, Das I, Sutula TP. Neuronal loss induced in limbic pathways by kindling: evidence for induction of hippocampal sclerosis by repeated brief seizures. J Neurosci. May 1994;14(5 pt 2):3106-21. [Medline].

  8. Sutula T, Cascino G, Cavazos J, et al. Mossy fiber synaptic reorganization in the epileptic human temporal lobe. Ann Neurol. Sep 1989;26(3):321-30. [Medline].

  9. McCormick DA. Cellular mechanisms underlying cholinergic and noradrenergic modulation of neuronal firing mode in the cat and guinea pig dorsal lateral geniculate nucleus. J Neurosci. Jan 1992;12(1):278-89. [Medline].

  10. Hosford DA, Clark S, Cao Z, et al. The role of GABAB receptor activation in absence seizures of lethargic (lh/lh) mice. Science. Jul 17 1992;257(5068):398-401. [Medline].

  11. Luders H, Acharya J, Baumgartner C, et al. Semiological seizure classification. Epilepsia. Sep 1998;39(9):1006-13. [Medline].

  12. Loddenkemper T, Kellinghaus C, Wyllie E, Najm IM, Gupta A, Rosenow F. A proposal for a five-dimensional patient-oriented epilepsy classification. Epileptic Disord. Dec 2005;7(4):308-16. [Medline].

  13. Engel J Jr. Report of the ILAE classification core group. Epilepsia. Sep 2006;47(9):1558-68. [Medline].

  14. Wolf P. Basic principles of the ILAE syndrome classification. Epilepsy Res. Aug 2006;70 suppl 1:S20-6. [Medline].

  15. Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. Apr 2010;51(4):676-85. [Medline].

  16. Engel J Jr. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia. Jun 2001;42(6):796-803. [Medline].

  17. Wolf P. Of cabbages and kings: some considerations on classifications, diagnostic schemes, semiology, and concepts. Epilepsia. Jan 2003;44(1):1-4; discussion 4-13. [Medline].

  18. Beghi E. The concept of the epilepsy syndrome: how useful is it in clinical practice?. Epilepsia. May 2009;50 suppl 5:4-10. [Medline].

  19. First Seizure Trial Group (FIR.S.T Group). Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology. Mar 1993;43(3 pt 1):478-83. [Medline].

  20. [Best Evidence] Glauser TA, Cnaan A, Shinnar S, et al, for the Childhood Absence Epilepsy Study Group. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. Mar 4 2010;362(9):790-9. [Medline].

  21. Ng YT, Conry JA, Drummond R, Stolle J, Weinberg MA. Randomized, phase III study results of clobazam in Lennox-Gastaut syndrome. Neurology. Oct 11 2011;77(15):1473-1481. [Medline].

  22. [Best Evidence] Marson AG, Al-Kharusi AM, Alwaidh M, et al, for the SANAD Study group. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet. Mar 24 2007;369(9566):1016-26. [Medline].

  23. Mattson RH, Cramer JA, Collins JF, et al. Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med. Jul 18 1985;313(3):145-51. [Medline].

  24. Mattson RH, Cramer JA, Collins JF. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. N Engl J Med. Sep 10 1992;327(11):765-71. [Medline].

  25. [Best Evidence] Rowan AJ, Ramsay RE, Collins JF, et al, for the VA Cooperative Study 428 Group. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. Jun 14 2005;64(11):1868-73. [Medline].

  26. [Best Evidence] Marson AG, Al-Kharusi AM, Alwaidh M, et al, for the SANAD Study Group. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet. Mar 24 2007;369(9566):1000-15. [Medline].

  27. French JA, Kanner AM, Bautista J, et al, for the Therapeutics and Technology Assessment Subcommittee of the AAN; Quality Standards Subcommittee of the AAN; and AES. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. Apr 27 2004;62(8):1252-60. [Medline].

  28. French JA, Kanner AM, Bautista J, et al for the Therapeutics and Technology Assessment Subcommittee of the AAN; Quality Standards Subcommittee of the AAN; and AES. Efficacy and tolerability of the new antiepileptic drugs, II: treatment of refractory epilepsy. Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. Apr 27 2004;62(8):1261-73. [Medline].

  29. [Guideline] Harden CL, Hopp J, Ting TY, et al, for the AAN and AES. Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. May 2009;50(5):1229-36. [Medline].

  30. [Guideline] Harden CL, Meador KJ, Pennell PB, et al, for the AAN and AES. Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. May 2009;50(5):1237-46. [Medline].

  31. [Guideline] Harden CL, Pennell PB, Koppel BS, et al, for the AAN and AES. Management issues for women with epilepsy--focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. May 2009;50(5):1247-55. [Medline].

  32. Kossoff EH, Turner Z, Bluml RM, Pyzik PL, Vining EP. A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet. Epilepsy Behav. May 2007;10(3):432-6. [Medline].

  33. [Best Evidence] Wiebe S, Blume WT, Girvin JP, Eliasziw M, for the Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. Aug 2 2001;345(5):311-8. [Medline].

 
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