Temporal Lobe Epilepsy Differential Diagnoses

Updated: Apr 29, 2014
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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DDx

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