Epilepsy differential diagnosis: Difference between revisions

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** Psychogenic non epileptic attacks most commonly happens in young women and is the most common disease misdiagnosed with [[epilepsy]].<ref name="pmid15329081">{{cite journal |vauthors=Benbadis SR, O'Neill E, Tatum WO, Heriaud L |title=Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center |journal=Epilepsia |volume=45 |issue=9 |pages=1150–3 |date=September 2004 |pmid=15329081 |doi=10.1111/j.0013-9580.2004.14504.x |url=}}</ref><ref name="pmid16531122">{{cite journal |vauthors=Behrouz R, Heriaud L, Benbadis SR |title=Late-onset psychogenic nonepileptic seizures |journal=Epilepsy Behav |volume=8 |issue=3 |pages=649–50 |date=May 2006 |pmid=16531122 |doi=10.1016/j.yebeh.2006.02.003 |url=}}</ref><ref name="pmid16769934">{{cite journal |vauthors=Duncan R, Oto M, Martin E, Pelosi A |title=Late onset psychogenic nonepileptic attacks |journal=Neurology |volume=66 |issue=11 |pages=1644–7 |date=June 2006 |pmid=16769934 |doi=10.1212/01.wnl.0000223320.94812.7a |url=}}</ref>
** Psychogenic non epileptic attacks most commonly happens in young women and is the most common disease misdiagnosed with [[epilepsy]].<ref name="pmid15329081">{{cite journal |vauthors=Benbadis SR, O'Neill E, Tatum WO, Heriaud L |title=Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center |journal=Epilepsia |volume=45 |issue=9 |pages=1150–3 |date=September 2004 |pmid=15329081 |doi=10.1111/j.0013-9580.2004.14504.x |url=}}</ref><ref name="pmid16531122">{{cite journal |vauthors=Behrouz R, Heriaud L, Benbadis SR |title=Late-onset psychogenic nonepileptic seizures |journal=Epilepsy Behav |volume=8 |issue=3 |pages=649–50 |date=May 2006 |pmid=16531122 |doi=10.1016/j.yebeh.2006.02.003 |url=}}</ref><ref name="pmid16769934">{{cite journal |vauthors=Duncan R, Oto M, Martin E, Pelosi A |title=Late onset psychogenic nonepileptic attacks |journal=Neurology |volume=66 |issue=11 |pages=1644–7 |date=June 2006 |pmid=16769934 |doi=10.1212/01.wnl.0000223320.94812.7a |url=}}</ref>
** There are some features which can help us differentiate PNEAs from [[epilepsy]]:
** There are some features which can help us differentiate PNEAs from [[epilepsy]]:
*** These patients are resistance to [[anti-epileptic drugs]].<ref name="pmid10023117">{{cite journal |vauthors=Benbadis SR |title=How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis? |journal=Eur. Neurol. |volume=41 |issue=2 |pages=114–5 |date=1999 |pmid=10023117 |doi=10.1159/000008015 |url=}}</ref>  
*** These patients are resistance to [[anti-epileptic drugs]].<ref name="pmid10023117">{{cite journal |vauthors=Benbadis SR |title=How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis? |journal=Eur. Neurol. |volume=41 |issue=2 |pages=114–5 |date=1999 |pmid=10023117 |doi=10.1159/000008015 |url=}}</ref>
*** PNEAs rarely happens in sleep and mostly happens in the present of an audience.<ref name="pmid8710126">{{cite journal |vauthors=Benbadis SR, Lancman ME, King LM, Swanson SJ |title=Preictal pseudosleep: a new finding in psychogenic seizures |journal=Neurology |volume=47 |issue=1 |pages=63–7 |date=July 1996 |pmid=8710126 |doi= |url=}}</ref>
*** PNEAs rarely happens in sleep and mostly happens in the present of an audience.<ref name="pmid8710126">{{cite journal |vauthors=Benbadis SR, Lancman ME, King LM, Swanson SJ |title=Preictal pseudosleep: a new finding in psychogenic seizures |journal=Neurology |volume=47 |issue=1 |pages=63–7 |date=July 1996 |pmid=8710126 |doi= |url=}}</ref>
*** In physical examination of PNEAs patients we can observe histrionic features.<ref name="pmid7487261">{{cite journal |vauthors=Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F |title=Value of tongue biting in the diagnosis of seizures |journal=Arch. Intern. Med. |volume=155 |issue=21 |pages=2346–9 |date=November 1995 |pmid=7487261 |doi= |url=}}</ref>
*** In physical examination of PNEAs patients we can observe histrionic features.<ref name="pmid7487261">{{cite journal |vauthors=Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F |title=Value of tongue biting in the diagnosis of seizures |journal=Arch. Intern. Med. |volume=155 |issue=21 |pages=2346–9 |date=November 1995 |pmid=7487261 |doi= |url=}}</ref>
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* [[Syncope]]:
* [[Syncope]]:
** Syncope is another misdiagnosed disease with epilepsy. The reason for this misdiagnosis is that [[syncope]] attacks happens in a convulsive manner and patients may have body [[Jerking|jerks]] and clonic movement.<ref name="pmid3369769">{{cite journal |vauthors=Aminoff MJ, Scheinman MM, Griffin JC, Herre JM |title=Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias |journal=Ann. Intern. Med. |volume=108 |issue=6 |pages=791–6 |date=June 1988 |pmid=3369769 |doi= |url=}}</ref>  
** Syncope is another misdiagnosed disease with epilepsy. The reason for this misdiagnosis is that [[syncope]] attacks happens in a convulsive manner and patients may have body [[Jerking|jerks]] and clonic movement.<ref name="pmid3369769">{{cite journal |vauthors=Aminoff MJ, Scheinman MM, Griffin JC, Herre JM |title=Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias |journal=Ann. Intern. Med. |volume=108 |issue=6 |pages=791–6 |date=June 1988 |pmid=3369769 |doi= |url=}}</ref>
** [[Syncope]] also cause [[EEG]] changes and make it more difficult to differentiate it from epilepsy.<ref name="pmid9676166">{{cite journal |vauthors=Sheldon RS, Koshman ML, Murphy WF |title=Electroencephalographic findings during presyncope and syncope induced by tilt table testing |journal=Can J Cardiol |volume=14 |issue=6 |pages=811–6 |date=June 1998 |pmid=9676166 |doi= |url=}}</ref>
** [[Syncope]] also cause [[EEG]] changes and make it more difficult to differentiate it from epilepsy.<ref name="pmid9676166">{{cite journal |vauthors=Sheldon RS, Koshman ML, Murphy WF |title=Electroencephalographic findings during presyncope and syncope induced by tilt table testing |journal=Can J Cardiol |volume=14 |issue=6 |pages=811–6 |date=June 1998 |pmid=9676166 |doi= |url=}}</ref>
** There are some presyncope symptoms such as sweating, [[dizziness]], [[nausea]] and [[malaise]] which helps us differentiate it from epilepsy.<ref name="pmid12103268">{{cite journal |vauthors=Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA, Frenneaux M, Fisher M, Murphy W |title=Historical criteria that distinguish syncope from seizures |journal=J. Am. Coll. Cardiol. |volume=40 |issue=1 |pages=142–8 |date=July 2002 |pmid=12103268 |doi= |url=}}</ref>
** There are some presyncope symptoms such as sweating, [[dizziness]], [[nausea]] and [[malaise]] which helps us differentiate it from epilepsy.<ref name="pmid12103268">{{cite journal |vauthors=Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA, Frenneaux M, Fisher M, Murphy W |title=Historical criteria that distinguish syncope from seizures |journal=J. Am. Coll. Cardiol. |volume=40 |issue=1 |pages=142–8 |date=July 2002 |pmid=12103268 |doi= |url=}}</ref>
* [[Hypoglycemia]]  
* [[Hypoglycemia]]  
* Panic attacks: [[Panic attack|Panic attacks]] mostly resemble PNEAs rather than epilepsy.<ref name="pmid10767885">{{cite journal |vauthors=Merritt TC |title=Recognition and acute management of patients with panic attacks in the emergency department |journal=Emerg. Med. Clin. North Am. |volume=18 |issue=2 |pages=289–300, ix |date=May 2000 |pmid=10767885 |doi= |url=}}</ref><ref name="pmid7988943">{{cite journal |vauthors=Vein AM, Djukova GM, Vorobieva OV |title=Is panic attack a mask of psychogenic seizures?--a comparative analysis of phenomenology of psychogenic seizures and panic attacks |journal=Funct. Neurol. |volume=9 |issue=3 |pages=153–9 |date=1994 |pmid=7988943 |doi= |url=}}</ref> In mesiotemporal epilepsy the patient experience fear as an [[aura]] and it can be mistaken with [[panic attack]] specially if the typical [[seizure]] doesn’t happen after [[aura]].<ref name="pmid11160466">{{cite journal |vauthors=Biraben A, Taussig D, Thomas P, Even C, Vignal JP, Scarabin JM, Chauvel P |title=Fear as the main feature of epileptic seizures |journal=J. Neurol. Neurosurg. Psychiatry |volume=70 |issue=2 |pages=186–91 |date=February 2001 |pmid=11160466 |pmc=1737203 |doi= |url=}}</ref>
* Panic attacks: [[Panic attack|Panic attacks]] mostly resemble PNEAs rather than epilepsy.<ref name="pmid10767885">{{cite journal |vauthors=Merritt TC |title=Recognition and acute management of patients with panic attacks in the emergency department |journal=Emerg. Med. Clin. North Am. |volume=18 |issue=2 |pages=289–300, ix |date=May 2000 |pmid=10767885 |doi= |url=}}</ref><ref name="pmid7988943">{{cite journal |vauthors=Vein AM, Djukova GM, Vorobieva OV |title=Is panic attack a mask of psychogenic seizures?--a comparative analysis of phenomenology of psychogenic seizures and panic attacks |journal=Funct. Neurol. |volume=9 |issue=3 |pages=153–9 |date=1994 |pmid=7988943 |doi= |url=}}</ref> In mesiotemporal epilepsy the patient experience fear as an [[aura]] and it can be mistaken with [[panic attack]] specially if the typical [[seizure]] doesn’t happen after [[aura]].<ref name="pmid11160466">{{cite journal |vauthors=Biraben A, Taussig D, Thomas P, Even C, Vignal JP, Scarabin JM, Chauvel P |title=Fear as the main feature of epileptic seizures |journal=J. Neurol. Neurosurg. Psychiatry |volume=70 |issue=2 |pages=186–91 |date=February 2001 |pmid=11160466 |pmc=1737203 |doi= |url=}}</ref>
* Acute dystonic reactions: Drugs such as [[Antidopaminergic|anti-dopaminergic]], [[Antiemetic|anti-emetics]], [[carbamazepine]], [[lithium]] and [[trazodone]] can cause twisting movements of craniopharyngeal and cervical muscles for seconds to hours. This condition response very well to [[anticholinergic]] treatment.<ref name="pmid16208529">{{cite journal |vauthors=Dressler D, Benecke R |title=Diagnosis and management of acute movement disorders |journal=J. Neurol. |volume=252 |issue=11 |pages=1299–306 |date=November 2005 |pmid=16208529 |doi=10.1007/s00415-005-0006-x |url=}}</ref>
* Acute dystonic reactions: Drugs such as [[Antidopaminergic|anti-dopaminergic]], [[Antiemetic|anti-emetics]], [[carbamazepine]], [[lithium]] and [[trazodone]] can cause twisting movements of craniopharyngeal and cervical muscles for seconds to hours. This condition response very well to [[anticholinergic]] treatment.<ref name="pmid16208529">{{cite journal |vauthors=Dressler D, Benecke R |title=Diagnosis and management of acute movement disorders |journal=J. Neurol. |volume=252 |issue=11 |pages=1299–306 |date=November 2005 |pmid=16208529 |doi=10.1007/s00415-005-0006-x |url=}}</ref>


* Hemifacial spasm: [[Hemifacial spasm]] ([[Hemifacial spasm|HFS]]) can be mistaken with [[simple partial seizure]] or facial clonic seizure. There are some features which helps us to differentiate it from epilepsy:
* Hemifacial spasm: [[Hemifacial spasm]] ([[Hemifacial spasm|HFS]]) can be mistaken with [[simple partial seizure]] or facial clonic seizure. There are some features which helps us to differentiate it from epilepsy:
** [[Hemifacial spasm|HFS]] is a progressive and chronic condition and it’s not a paroxysmal phenomenon.
**[[Hemifacial spasm|HFS]] is a progressive and chronic condition and it’s not a paroxysmal phenomenon.
** In partial epilepsy we have involvement of perioral muscle but [[Hemifacial spasm|HFS]] mostly involves periorbital muscles.<ref name="pmid16533973">{{cite journal |vauthors=Colosimo C, Bologna M, Lamberti S, Avanzino L, Avanzino L, Marinelli L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A |title=A comparative study of primary and secondary hemifacial spasm |journal=Arch. Neurol. |volume=63 |issue=3 |pages=441–4 |date=March 2006 |pmid=16533973 |doi=10.1001/archneur.63.3.441 |url=}}</ref>
** In partial epilepsy we have involvement of perioral muscle but [[Hemifacial spasm|HFS]] mostly involves periorbital muscles.<ref name="pmid16533973">{{cite journal |vauthors=Colosimo C, Bologna M, Lamberti S, Avanzino L, Avanzino L, Marinelli L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A |title=A comparative study of primary and secondary hemifacial spasm |journal=Arch. Neurol. |volume=63 |issue=3 |pages=441–4 |date=March 2006 |pmid=16533973 |doi=10.1001/archneur.63.3.441 |url=}}</ref>
* Nonepileptic [[myoclonus]]  
* Nonepileptic [[myoclonus]]  
* [[Parasomnia|Parasomnias]]: Non-REM parasomnias such as [[Night terror|night terrors]] and [[sleepwalking]] can misdiagnosed with epilepsy specially because they are paroxysmal and can cause [[amnesia]] and unresponsiveness. These patients have normal [[EEG]] and their attacks mostly starts in a specific stage of sleep.<ref name="pmid16682539">{{cite journal |vauthors=Derry CP, Davey M, Johns M, Kron K, Glencross D, Marini C, Scheffer IE, Berkovic SF |title=Distinguishing sleep disorders from seizures: diagnosing bumps in the night |journal=Arch. Neurol. |volume=63 |issue=5 |pages=705–9 |date=May 2006 |pmid=16682539 |doi=10.1001/archneur.63.5.705 |url=}}</ref><ref name="pmid16043794">{{cite journal |vauthors=Iranzo A, Santamaría J, Rye DB, Valldeoriola F, Martí MJ, Muñoz E, Vilaseca I, Tolosa E |title=Characteristics of idiopathic REM sleep behavior disorder and that associated with MSA and PD |journal=Neurology |volume=65 |issue=2 |pages=247–52 |date=July 2005 |pmid=16043794 |doi=10.1212/01.wnl.0000168864.97813.e0 |url=}}</ref>  
* [[Parasomnia|Parasomnias]]: Non-REM parasomnias such as [[Night terror|night terrors]] and [[sleepwalking]] can misdiagnosed with epilepsy specially because they are paroxysmal and can cause [[amnesia]] and unresponsiveness. These patients have normal [[EEG]] and their attacks mostly starts in a specific stage of sleep.<ref name="pmid16682539">{{cite journal |vauthors=Derry CP, Davey M, Johns M, Kron K, Glencross D, Marini C, Scheffer IE, Berkovic SF |title=Distinguishing sleep disorders from seizures: diagnosing bumps in the night |journal=Arch. Neurol. |volume=63 |issue=5 |pages=705–9 |date=May 2006 |pmid=16682539 |doi=10.1001/archneur.63.5.705 |url=}}</ref><ref name="pmid16043794">{{cite journal |vauthors=Iranzo A, Santamaría J, Rye DB, Valldeoriola F, Martí MJ, Muñoz E, Vilaseca I, Tolosa E |title=Characteristics of idiopathic REM sleep behavior disorder and that associated with MSA and PD |journal=Neurology |volume=65 |issue=2 |pages=247–52 |date=July 2005 |pmid=16043794 |doi=10.1212/01.wnl.0000168864.97813.e0 |url=}}</ref>
* Cataplexy: [[Cataplexy]] commonly misdiagnosed with [[Atonic seizure|atonic seizures]] ([[Drop attack|drop attacks]]) These attacks mostly trigger by emotion such as laughter.<ref name="pmid8848983">{{cite journal |vauthors=Guilleminault C, Gelb M |title=Clinical aspects and features of cataplexy |journal=Adv Neurol |volume=67 |issue= |pages=65–77 |date=1995 |pmid=8848983 |doi= |url=}}</ref><ref name="pmid10767653">{{cite journal |vauthors=Krahn LE, Boeve BF, Olson EJ, Herold DL, Silber MH |title=A standardized test for cataplexy |journal=Sleep Med. |volume=1 |issue=2 |pages=125–130 |date=April 2000 |pmid=10767653 |doi= |url=}}</ref>  
* Cataplexy: [[Cataplexy]] commonly misdiagnosed with [[Atonic seizure|atonic seizures]] ([[Drop attack|drop attacks]]) These attacks mostly trigger by emotion such as laughter.<ref name="pmid8848983">{{cite journal |vauthors=Guilleminault C, Gelb M |title=Clinical aspects and features of cataplexy |journal=Adv Neurol |volume=67 |issue= |pages=65–77 |date=1995 |pmid=8848983 |doi= |url=}}</ref><ref name="pmid10767653">{{cite journal |vauthors=Krahn LE, Boeve BF, Olson EJ, Herold DL, Silber MH |title=A standardized test for cataplexy |journal=Sleep Med. |volume=1 |issue=2 |pages=125–130 |date=April 2000 |pmid=10767653 |doi= |url=}}</ref>
* Hypnic jerks: Hypanic jerk is a very common condition which happens at the beginning of sleep resembles [[Myoclonic seizure|myoclonic seizures]].<ref name="pmid2456194">{{cite journal |vauthors=Montagna P, Liguori R, Zucconi M, Sforza E, Lugaresi A, Cirignotta F, Lugaresi E |title=Physiological hypnic myoclonus |journal=Electroencephalogr Clin Neurophysiol |volume=70 |issue=2 |pages=172–6 |date=August 1988 |pmid=2456194 |doi= |url=}}</ref>  
* Hypnic jerks: Hypanic jerk is a very common condition which happens at the beginning of sleep resembles [[Myoclonic seizure|myoclonic seizures]].<ref name="pmid2456194">{{cite journal |vauthors=Montagna P, Liguori R, Zucconi M, Sforza E, Lugaresi A, Cirignotta F, Lugaresi E |title=Physiological hypnic myoclonus |journal=Electroencephalogr Clin Neurophysiol |volume=70 |issue=2 |pages=172–6 |date=August 1988 |pmid=2456194 |doi= |url=}}</ref>
* [[Transient ischemic attacks]]: The key difference between [[Transient ischemic attack|TIA]] and [[seizure]] is [[TIA]] attacks have negative symptoms instead of positive symptoms we observe in [[Seizure|seizures]].<ref name="pmid15505181">{{cite journal |vauthors=Han SW, Kim SH, Kim JK, Park CH, Yun MJ, Heo JH |title=Hemodynamic changes in limb shaking TIA associated with anterior cerebral artery stenosis |journal=Neurology |volume=63 |issue=8 |pages=1519–21 |date=October 2004 |pmid=15505181 |doi= |url=}}</ref>  
* [[Transient ischemic attacks]]: The key difference between [[Transient ischemic attack|TIA]] and [[seizure]] is [[TIA]] attacks have negative symptoms instead of positive symptoms we observe in [[Seizure|seizures]].<ref name="pmid15505181">{{cite journal |vauthors=Han SW, Kim SH, Kim JK, Park CH, Yun MJ, Heo JH |title=Hemodynamic changes in limb shaking TIA associated with anterior cerebral artery stenosis |journal=Neurology |volume=63 |issue=8 |pages=1519–21 |date=October 2004 |pmid=15505181 |doi= |url=}}</ref>
* [[Migraine|Migraines]]  
* [[Migraine|Migraines]]  
* [[Transient global amnesia]]: Patients with this condition experience periods of [[anterograde amnesia]] for few hours which resolves on its own.<ref name="pmid16670178">{{cite journal |vauthors=Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, Desgranges B, Eustache F |title=What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases |journal=Brain |volume=129 |issue=Pt 7 |pages=1640–58 |date=July 2006 |pmid=16670178 |doi=10.1093/brain/awl105 |url=}}</ref>
* [[Transient global amnesia]]: Patients with this condition experience periods of [[anterograde amnesia]] for few hours which resolves on its own.<ref name="pmid16670178">{{cite journal |vauthors=Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, Desgranges B, Eustache F |title=What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases |journal=Brain |volume=129 |issue=Pt 7 |pages=1640–58 |date=July 2006 |pmid=16670178 |doi=10.1093/brain/awl105 |url=}}</ref>
 
A quick algorithm to differentiate epilepsy from other causes of altered mental status is demonstrated below:
 
{{familytree/start}}
{{familytree | | | | | | | | | | A01 | | | | | |A01='''Clinical presentation'''}}
{{familytree | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | B01 | | | | | |B01=Loss of conscoiusness}}
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.|}}
{{familytree | | | C01 | | | | | | | | | | | | C02 |C01=No|C02=Yes}}
{{familytree | | | |!| | | | | | | | | | | | | |!| | | | | | | | | | | }}
{{familytree | | | |!| | | | | | | | | | | | | D02 |D02=• Transient?<br>• Rapid onset?<br>• Short duration?<br>• Spontaneous recovery?}}
{{familytree | |,|-|^|-|.| | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.|}}
{{familytree | F04 | | F05 | | | | G04 | | | | | | | | | | G05 |F04=Falls|F05=Altered consciousnes|G04=Yes|G05=No}}
{{familytree | | | | | | | | | | | |!| | | | | | | |,|-|-|-|+|-|-|-|.|}}
{{familytree | | | | | | | | | | | |!| | | | | | | E02 | | E03 | | E04 |E02=[[Coma]]|E03=Aborted SCD|E04=Others}}
{{familytree | | | | | | | | | | | D01 | | | | | | | | | | | | | |D01=T-LOC}}
{{familytree | | | | | | | | | |,|-|^|-|.| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | D02 | | D03 | | | | | | | | | | | |D02=Non-Traumatic|D03=Traumatic}}
{{familytree | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|.| | | | | | | | | |}}
{{familytree | D04 | | | D05 | | | | D06 | | | D07| |D04=Syncope|D05=Epileptic seizure|D06=Psychogenic|D07=Rare causes}}
{{familytree | |!| | | | |!| | | | | |!| | | | | | | | | | | | | | |}}
{{familytree | B04 | | | B05 | | | | B06 | | | | | | | | | | | | |B04=• Reflex syncope<br>• [[Orthostatic hypotension]]<br>• [[Cardiac]] syncope|B05=• Tonic<br>• Clonic<br>• Tonic-clonic<br>• Atonic|B06=• Pseudo-epileptic<br>• Pseudo-syncopal}}
{{familytree/end}}
<small><small>
'''Abbreviations:''' '''SCD''': Sudden cardiac death;'''T-LOC''': Transient-Loss of consciousness.
</small></small>
{|
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==References==
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Latest revision as of 21:37, 29 July 2020

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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]

A quick algorithm to differentiate epilepsy from other causes of altered mental status is demonstrated below:

 
 
 
 
 
 
 
 
 
Clinical presentation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Loss of conscoiusness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Transient?
• Rapid onset?
• Short duration?
• Spontaneous recovery?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Falls
 
Altered consciousnes
 
 
 
Yes
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Coma
 
Aborted SCD
 
Others
 
 
 
 
 
 
 
 
 
 
T-LOC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-Traumatic
 
Traumatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Syncope
 
 
Epileptic seizure
 
 
 
Psychogenic
 
 
Rare causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Reflex syncope
• Orthostatic hypotension
• Cardiac syncope
 
 
• Tonic
• Clonic
• Tonic-clonic
• Atonic
 
 
 
• Pseudo-epileptic
• Pseudo-syncopal
 
 
 
 
 
 
 
 
 
 
 
 

Abbreviations: SCD: Sudden cardiac death;T-LOC: Transient-Loss of consciousness.

The above algorithm adopted from ESC guideline [23]

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.
  23. ↑ Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). "Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)". European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.

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