Epilepsy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Epilepsy must be differentiated from: Psychogenic nonepileptic attacks (PNEAs), syncope, hypoglycemia, panic attacks, acute dystonic reactions, hemifacial spasm, nonepileptic myoclonus, parasomnias, cataplexy, hypnic jerks, transient ischemic attacks, migraines and transient global amnesia.

Differentiating epilepsy from other Diseases

Epilepsy must be differentiated from:

  • Psychogenic nonepileptic attacks (PNEAs):
    • Psychogenic non epileptic attacks most commonly happens in young women and is the most common disease misdiagnosed with epilepsy.[1][2][3]
    • There are some features which can help us differentiate PNEAs from epilepsy:
      • These patients are resistance to anti-epileptic drugs.[4]
      • PNEAs rarely happens in sleep and mostly happens in the present of an audience.[5]
      • In physical examination of PNEAs patients we can observe histrionic features.[6]
      • Tongue biting, urine incontinence and postictal confusion are in favor of epilepsy.[6]
      • In PNEAs we have normal EEGs.[7]


References

  1. Benbadis SR, O'Neill E, Tatum WO, Heriaud L (September 2004). "Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center". Epilepsia. 45 (9): 1150–3. doi:10.1111/j.0013-9580.2004.14504.x. PMID 15329081.
  2. Behrouz R, Heriaud L, Benbadis SR (May 2006). "Late-onset psychogenic nonepileptic seizures". Epilepsy Behav. 8 (3): 649–50. doi:10.1016/j.yebeh.2006.02.003. PMID 16531122.
  3. Duncan R, Oto M, Martin E, Pelosi A (June 2006). "Late onset psychogenic nonepileptic attacks". Neurology. 66 (11): 1644–7. doi:10.1212/01.wnl.0000223320.94812.7a. PMID 16769934.
  4. Benbadis SR (1999). "How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis?". Eur. Neurol. 41 (2): 114–5. doi:10.1159/000008015. PMID 10023117.
  5. Benbadis SR, Lancman ME, King LM, Swanson SJ (July 1996). "Preictal pseudosleep: a new finding in psychogenic seizures". Neurology. 47 (1): 63–7. PMID 8710126.
  6. 6.0 6.1 Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F (November 1995). "Value of tongue biting in the diagnosis of seizures". Arch. Intern. Med. 155 (21): 2346–9. PMID 7487261.
  7. Davis BJ (2004). "Predicting nonepileptic seizures utilizing seizure frequency, EEG, and response to medication". Eur. Neurol. 51 (3): 153–6. doi:10.1159/000077287. PMID 15017116.
  8. Aminoff MJ, Scheinman MM, Griffin JC, Herre JM (June 1988). "Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias". Ann. Intern. Med. 108 (6): 791–6. PMID 3369769.
  9. Sheldon RS, Koshman ML, Murphy WF (June 1998). "Electroencephalographic findings during presyncope and syncope induced by tilt table testing". Can J Cardiol. 14 (6): 811–6. PMID 9676166.
  10. Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA, Frenneaux M, Fisher M, Murphy W (July 2002). "Historical criteria that distinguish syncope from seizures". J. Am. Coll. Cardiol. 40 (1): 142–8. PMID 12103268.
  11. Merritt TC (May 2000). "Recognition and acute management of patients with panic attacks in the emergency department". Emerg. Med. Clin. North Am. 18 (2): 289–300, ix. PMID 10767885.
  12. Vein AM, Djukova GM, Vorobieva OV (1994). "Is panic attack a mask of psychogenic seizures?--a comparative analysis of phenomenology of psychogenic seizures and panic attacks". Funct. Neurol. 9 (3): 153–9. PMID 7988943.
  13. Biraben A, Taussig D, Thomas P, Even C, Vignal JP, Scarabin JM, Chauvel P (February 2001). "Fear as the main feature of epileptic seizures". J. Neurol. Neurosurg. Psychiatry. 70 (2): 186–91. PMC 1737203. PMID 11160466.
  14. Dressler D, Benecke R (November 2005). "Diagnosis and management of acute movement disorders". J. Neurol. 252 (11): 1299–306. doi:10.1007/s00415-005-0006-x. PMID 16208529.
  15. Colosimo C, Bologna M, Lamberti S, Avanzino L, Avanzino L, Marinelli L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A (March 2006). "A comparative study of primary and secondary hemifacial spasm". Arch. Neurol. 63 (3): 441–4. doi:10.1001/archneur.63.3.441. PMID 16533973.
  16. Derry CP, Davey M, Johns M, Kron K, Glencross D, Marini C, Scheffer IE, Berkovic SF (May 2006). "Distinguishing sleep disorders from seizures: diagnosing bumps in the night". Arch. Neurol. 63 (5): 705–9. doi:10.1001/archneur.63.5.705. PMID 16682539.
  17. Iranzo A, Santamaría J, Rye DB, Valldeoriola F, Martí MJ, Muñoz E, Vilaseca I, Tolosa E (July 2005). "Characteristics of idiopathic REM sleep behavior disorder and that associated with MSA and PD". Neurology. 65 (2): 247–52. doi:10.1212/01.wnl.0000168864.97813.e0. PMID 16043794.
  18. Guilleminault C, Gelb M (1995). "Clinical aspects and features of cataplexy". Adv Neurol. 67: 65–77. PMID 8848983.
  19. Krahn LE, Boeve BF, Olson EJ, Herold DL, Silber MH (April 2000). "A standardized test for cataplexy". Sleep Med. 1 (2): 125–130. PMID 10767653.
  20. Montagna P, Liguori R, Zucconi M, Sforza E, Lugaresi A, Cirignotta F, Lugaresi E (August 1988). "Physiological hypnic myoclonus". Electroencephalogr Clin Neurophysiol. 70 (2): 172–6. PMID 2456194.
  21. Han SW, Kim SH, Kim JK, Park CH, Yun MJ, Heo JH (October 2004). "Hemodynamic changes in limb shaking TIA associated with anterior cerebral artery stenosis". Neurology. 63 (8): 1519–21. PMID 15505181.
  22. Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, Desgranges B, Eustache F (July 2006). "What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases". Brain. 129 (Pt 7): 1640–58. doi:10.1093/brain/awl105. PMID 16670178.

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