Diagnostic Considerations

If a case of posttraumatic epilepsy (PTE) demonstrates atypical features and the seizures continue despite treatment, consider the possibility of pseudoseizures. Hudak et al found that in patients with refractory PTE following moderate traumatic brain injury, about 20-30% proved to have psychogenic attacks.^[12]This percentage is similar to that in patients with seizures after nontraumatic brain injury. With severe TBI, some patients have posttraumatic stress disorder, which can contribute to pseudoseizures.

Therefore, in intractable epilepsy patients, the diagnosis should be verified by video-EEG monitoring, which shows that the nature of the seizures is psychogenic rather than epileptic. Some frontal lobe seizures may have bizarre features, so caution should be used if basing the decision solely on clinical features. Video-EEG is very helpful in these patients for distinguishing true epileptic from nonepileptic seizures; for those with epileptic seizures, it may allow further workup for epilepsy surgery or vagus nerve stimulation.

Differential Diagnoses

Benign Childhood Epilepsy
Complex Partial Seizures
Confusional States and Acute Memory Disorders
Dizziness, Vertigo, and Imbalance
Frontal Lobe Epilepsy
Generalized Tonic-Clonic Seizures
Head Injury
Neonatal Seizures
Psychogenic Nonepileptic Seizures
Temporal Lobe Epilepsy

Workup

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Author

David Y Ko, MD Associate Professor of Clinical Neurology, Loma Linda University School of Medicine

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SK<br/>Serve(d) as a speaker or a member of a speakers bureau for: Eisai, Lundbeck, Sunovion, Supernus, UCB.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS, FAES Professor with Tenure, Departments of Neurology, Neuroscience, and Physiology, Assistant Dean for the MD/PhD Program, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Brain Sentinel, consultant.<br/>Stakeholder (<5%), Co-founder for: Brain Sentinel.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani 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, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Alliance, Bioserenity, Ceribell, Eisai, Greenwich, LivaNova, Neurelis, Neuropace, Nexus, RSC, SK life science, Sunovion<br/>Serve(d) as a speaker or a member of a speakers bureau for: Alliance, Aquestive, Bioserenity, Eisai, Greenwich, LivaNova, Neurelis, SK life science, Sunovion<br/>Received research grant from: Cerevel, LivaNova, Greenwich, SK biopharmaceuticals, Takeda.

Acknowledgements

Nicholas Lorenzo, MD, CPE Chairman and CEO, Neurology Specialists and Consultants; Senior Vice President, Founding Executive Director, Continuing Medical Education, Gannett Education (Division Gannett Healthcare Group)

Nicholas Lorenzo, MD, CPE is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Ewa Posner, MD, MRCP Consultant Pediatrician, Department of Pediatrics, University Hospital of North Durham, UK

Ewa Posner, MD, MRCP is a member of the following medical societies: European Paediatric Neurology Society and Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.