Symptomatic Generalized Epilepsy Differential Diagnoses

Updated: Dec 11, 2018
  • Author: Emily Nakagawa, DO, MPH; Chief Editor: Selim R Benbadis, MD  more...
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DDx

Diagnostic Considerations

Not seizures

Generally, the differential diagnosis of seizures include syncope, psychogenic nonepileptic attacks, migraine, transient ischemic attack (TIA), gastrointestinal reflux resulting in Sandifer syndrome, REM behavior disorder, narcolepsy, cataplexy, parasomnia, tics, nonepileptic myoclonus, tremors, transient global ischemia, and panic.

In patients who are neurologically impaired (mental retardation or cerebral palsy), nonepileptic seizurelike behaviors can also be misinterpreted as seizures. These types of conditions include paroxysmal movement disorders (tonic spasms) associated with cerebral palsy, mannerisms, and self-stimulating repetitive behaviors, as well as nonepileptic staring spells.

Video-EEG is essential in ensuring that events are properly classified. Go to EEG in Common Epilepsy Syndromes and Generalized Epilepsies on EEG for more information.

Other types of epilepsy

Symptomatic generalized epilepsy (SGE) is different from idiopathic (primary) generalized epilepsy, which, by definition, has a genetic etiology and is not associated with evidence of brain dysfunction other than the seizures. Idiopathic (primary) generalized epilepsy (eg, childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy) is usually not difficult to differentiate because these patients are neurologically and intellectually normal, they do not have tonic or atonic seizures, and because EEG findings are normal other than the epileptiform abnormalities.