![]() The condition has been variously attributed to a migrainous mechanism, epilepsy, and movement disorder. It occurs in the presence of developmental regression and persistent developmental delay. ![]() Hemiplegia can occur on either side or bilaterally. Alternating hemiplegia is characterized by repeated bouts of dystonic posturing accompanied by nystagmus. 6 When the history suggests seizure, a careful differential diagnosis is important.Īlternating hemiplegia. Munchausen syndrome and Munchausen syn- drome by proxy also may present as seizures. A child with autism may have stereotyped movements that convince a concerned parent that the child is having seizures. Benign events, such as hypnic jerks, may prove very frightening to the parents of a child who recently suffered a febrile seizure. Parents of children who have health challenges that may include previous seizures may be very sensitive to any perceived abnormality in the child's health. Table 1 provides a brief overview of nonepileptic events that mimic specific seizure types that occur particularly in children. Benign or at least nonepileptic behaviors may be mistakenly identified as seizures or described in rather dramatic terms. Cerebral imaging studies may demonstrate a structural brain abnormality.Ĭertain circumstances can erroneously heighten suspicion of seizures by the patient, caregiver, and doctor. For example, mental retardation, cerebral palsy, or the presence of neurocutaneous lesions are noteworthy. They also help classify epilepsy as either symptomatic or idiopathic. Physical examination findings that indicate an abnormality of brain function provide further evidence of an increased likelihood of seizures. 4,5 A family history is important, since epilepsy in first-degree relatives is another risk factor. It is generally understood that relatively remote trauma of a minor degree confers very little risk, but prolonged loss of consciousness or a penetrating head injury are significant risk factors for seizure episodes. 3 An additional helpful clue from the history is a past brain injury from trauma or infection. For example, a history of febrile seizures (particularly if prolonged) is a well-recognized risk factor for development of temporal lobe epilepsy caused by mesial temporal sclerosis. Most often, seizure history related by the patient or family members and the physical findings will lead the physician to suspect epilepsy. The rationale for treating persons with recurrent seizures is that treatment will ameliorate seizure recurrence. Therefore, little advantage is gained by treating first-time seizures, whether they are provoked by an identified acute insult or they occur out of the blue. Seizure frequency and whether the seizures are generalized or partial have stronger predictive power. 2 Furthermore, the number of seizures that occur before treatment is initiated is not necessarily associated with a higher chance of medical intractability. Prolonged seizures cause brain injury, but epidemiologic studies have not provided evidence that prolonged first seizures in otherwise healthy persons increase the risk of subsequent seizures. Treatment with antiepileptic medication reduces the risk of a recurrence after a first event, but there is no evidence that treatment prevents the later development of epilepsy. ![]() 1 Increased risk of recurrence is associated with factors such as remote, symptomatic cause (eg, brain injury) abnormal EEG and seizure during sleep. The risk of recurrence within 2 years after a first-time, unprovoked seizure is approximately 35% to 40%. ![]() When epilepsy is attributed to a brain abnormality (eg, retardation, cerebral palsy, malformation), it is classified as symptomatic. The incidence is highest in early childhood and peaks again late in life. A careful, detailed history and physical examination supplemented by an EEG will, in most cases, result in a correct diagnosis.Įpileptic seizures are paroxysmal, unusual behaviors caused by abnormal, hypersynchronous firing of neurons (usually cortical). An orderly approach to the differential diagnosis of paroxysmal events is the best way to avoid misdiagnosis. Subtle behaviors such as inattentive staring may be attributed to attention deficit disorder but may be absence or complex partial seizures. Patients with convulsive, clonic movements may, in fact, be experiencing psychogenic events.Įpilepsy is often incorrectly diagnosed in these patients, who may be unnecessarily exposed to multiple seizure medications for many years and may never receive a correct diagnosis. It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. ![]()
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