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Other disorders to be considered in the differential diagnosis of epileptic seizures

 

Normal phenomena : may be normal for a particular individual

Paralytic syncope : due to impaired autonomic (self-controlled) function e. g. drug effects, autonomic disease of the nerves

Cardiac arrhythmias : especially in middle and older age but can occur in the young, may have palpitations (an awareness of a rapid, irregular or forceful beating of the heart), paleness in face/skin is common.

Other cardiac disorders : can sometimes produce focal neurological features from low output from the heart.

Panic attacks : fear, anxiety, light- headedness, abnormal sensation such as burning, prickling or resembling that of creeping of ants on the skin. Often in anxiety- inducing situations.

Hypoglycaemia : almost always in diabetes or alcoholics after excessive drinking, causing partial or complete unconsciousness, confusion, bizarre behavior, tremulousness, occasionally seizures.

Transient ischaemic attack (TIA) : usually older patients, need to differentiate from simple partial seizures.

Paroxysmal movement disorders : very rare, presents with sudden aimless muscles movements and involuntary motions or loss of posture, may be triggered by movement, could be mistaken for partial motor seizures.

Tonic spasm of multiple sclerosis (MS) : with intense focal sudden violent involuntary contractions of a muscle or group of muscles for less than a minute or longer, in patients with established MS.

Tics : multiple tics could be confused with myoclonic jerks, but in the most important disorder, Gilles de la Tourette, there is also an obsessive-compulsive behaviour with accompanying vocalisations.

Idiopathic drop attacks : occurs in middle- aged females, with sudden devastating falls without loss of consciousness, and therefore differs from the presentation of atonic seizures in children and young adults.

Migrainous aura : a march of less than a minute suggests partial seizures; over several minutes suggests migraine.

Transient global amnesia : usually >40 years, with amnesia (inability to recall the past events) lasting from 30 mins to a few hours.

Sleep- related episodes

Hypnic jerks: on falling asleep.

Sleep paralysis: frightening episodes on awakening or falling asleep.

Exploding head syndrome: sensation of bang, exploding on falling asleep.

Periodic movement of sleep: older patient, flexion of leg for a few seconds, at intervals of 10 60 seconds occurring in clusters for several minutes.

 

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