eMedicine Specialties > Neurology > Seizures and Epilepsy

Partial Epilepsies: Differential Diagnoses & Workup

Author: Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Coauthor(s): Vikas K Agrawal, MD, Staff Physician, Department of Neurology, University of South Florida
Contributor Information and Disclosures

Updated: Sep 10, 2009

Differential Diagnoses

Absence Seizures
Epilepsy in Children with Mental Retardation
Benign Childhood Epilepsy
Epilepsy, Juvenile Myoclonic
Epilepsia Partialis Continua
Epileptic and Epileptiform Encephalopathies
Epilepsy in Adults with Mental Retardation
Psychogenic Nonepileptic Seizures

Other Problems to Be Considered

Benign epilepsy syndromes, as follows:

Neonates
While sleeping - Head banging and benign neonatal myoclonus
While awake - Jitteriness, head banging, masturbation, benign myoclonus of epilepsy, spasmodic torticollis, spasms nutans, opsoclonus, rumination, startle disease or hyperexplexia, shuddering attacks, alternating hemiplegia, infantile apnea, cyanotic breath-holding spells, pallid syncope

Children
While sleeping - Hypnagogic paroxysmal dystonia, nightmares, night terrors, sleep walking
While awake - Chorea, tics, paroxysmal choreoathetosis, stereotypic movements, head nodding, headache, recurrent abdominal pain, confusional migraine, benign paroxysmal vertigo, stool-withholding activity, rage attacks, Münchhausen syndrome by proxy

Late childhood
While awake - Syncope, narcolepsy and/or cataplexy, basilar migraine, tremor, panic disorder

Workup

Laboratory Studies

  • At seizure onset, perform various tests to look for a clear cause. Because the type of seizure (partial vs generalized) often is not clear early on, investigate various causes of seizures, including structural abnormalities and toxic and metabolic disturbances.
    • Metabolic panel
    • Cerebrospinal fluid examination, if CNS infection is suspected (eg, fever, neck rigidity, mental status changes)
    • Level of anticonvulsant medication

Imaging Studies

  • CT scan of brain without contrast is easily and rapidly available and appropriate in an emergency setting.
  • MRI of the brain, with and without contrast, delineates structural detail and pathology; obtain a special temporal lobe cut for mesial temporal sclerosis.

Other Tests

  • EEG is extremely useful to confirm the diagnosis of epilepsy and to confirm a partial onset. The sensitivity of routine EEG is low but increases somewhat with repeated recordings.
  • When seizures are frequent (>1/wk), EEG-video monitoring allows a definitive diagnosis of epilepsy, including its type.

More on Partial Epilepsies

Overview: Partial Epilepsies
Differential Diagnoses & Workup: Partial Epilepsies
Treatment & Medication: Partial Epilepsies
Follow-up: Partial Epilepsies
Multimedia: Partial Epilepsies
References
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References

  1. Benbadis SR. Evaluation for surgical treatment of partial epilepsy: an overview. Wis Med J. 1995;94(9):500-4. [Medline].

  2. Benbadis SR. Epileptic seizures and syndromes. Neurol Clin. May 2001;19(2):251-70. [Medline].

  3. Benbadis SR, Luders HO. Epileptic syndromes: an underutilized concept. Epilepsia. Nov 1996;37(11):1029-34. [Medline].

  4. Benbadis SR, Tatum WO. Advances in the treatment of epilepsy. Am Fam Physician. Jul 1 2001;64(1):91-8. [Medline].

  5. Benbadis SR, Tatum WO. Overintepretation of EEGs and misdiagnosis of epilepsy. J Clin Neurophysiol. Feb 2003;20(1):42-4. [Medline].

  6. Benbadis SR, Tatum WO, Vale FL. When drugs don't work: an algorithmic approach to medically intractable epilepsy. Neurology. Dec 26 2000;55(12):1780-4. [Medline].

  7. Benbadis SR, Wolgamuth BR, Goren H, et al. Value of tongue biting in the diagnosis of seizures. Arch Intern Med. Nov 27 1995;155(21):2346-9. [Medline].

  8. Dichter MA, Brodie MJ. New antiepileptic drugs. N Engl J Med. Jun 13 1996;334(24):1583-90. [Medline].

  9. Engel J. Classifications of the International League Against Epilepsy: time for reappraisal. Epilepsia. Sep 1998;39(9):1014-7. [Medline].

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

  11. Tatum WO, Galvez R, Benbadis S, Carrazana E. New antiepileptic drugs: into the new millennium. Arch Fam Med. Nov-Dec 2000;9(10):1135-41. [Medline].

  12. Wyllie E. Treatment of Epilepsy: Principles and Practice. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996.

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Further Reading

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Keywords

partial epilepsy, focal epilepsy, localization-related epilepsy, simple partial seizures, SPS, complex partial seizures, CPS, epileptic disorder, childhood epilepsy of occipital paroxysms, benign childhood epilepsy with centrotemporal spikes, autosomal dominant nocturnal frontal lobe epilepsy, ADNFLE, mesial temporal lobe epilepsy, neocortical seizures, idiopathic epilepsies, partial epilepsies

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Contributor Information and Disclosures

Author

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

Coauthor(s)

Vikas K Agrawal, MD, Staff Physician, Department of Neurology, University of South Florida
Vikas K Agrawal, MD is a member of the following medical societies: American Academy of Neurology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Claude G Wasterlain, MD, Chair, Department of Neurology, VA Greater Los Angeles Health Care System; Distinguished Professor and Vice-Chair, Department of Neurology, University of California, Los Angeles, David Geffen School of Medicine
Claude G Wasterlain, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Federation for Medical Research, American Neurological Association, Royal Society of Medicine, and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, 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 Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Paul E Barkhaus, MD, Professor, Department of Neurology, Medical College of Wisconsin; Director of Neuromuscular Diseases, Milwaukee Veterans Administration Medical Center
Paul E Barkhaus, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association
Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

 
 
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