Epilepsy and Seizures Differential Diagnoses

Updated: Jul 26, 2022
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Diagnostic Considerations

The diagnosis of seizures is based on the patient’s clinical history. The history as related by a witness is of high importance, because many types of seizures are associated with impairment of consciousness, and patients are unaware of their occurrence.

The clinical diagnosis can be confirmed by abnormalities on the interictal electroencephalogram (EEG). However, these abnormalities can 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, hyponatremia)

  • Migraine (eg, migrainous aura, migraine equivalent)

  • Vascular conditions (eg, transient ischemic attacks)

  • Sleep disorders (eg, cataplexy, narcolepsy, night terror)

  • Movement disorders (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