Differential Diagnosis Of Epilepsy Research Articles

EEG Findings in a Patient with Holmes Tremor after AVM Surgery: A Case Report and Literature Review.

Background: Holmes tremor (HT) is a rare motor disorder characterized by high-amplitude and low-frequency resting, intentional, and postural tremors. HT typically arises from disruptions in neural pathways, including the dopaminergic system. Its causes include cerebrovascular incidents, neoplasms, demyelination, and infections. Diagnosis involves thorough clinical, neurophysiological, and neuroimaging assessments. Our report details the clinical profile, neuroimaging and EEG results and levodopa treatment response of an HT patient after cerebral arteriovenous malformation (AVM) surgery. Case Report: A female patient who underwent AVM surgery developed head tremor and dystonia. Neuroimaging revealed left thalamus involvement. Video electroencephalography (EEG) revealed high-amplitude, low-frequency tremors. The patient responded well to levodopa treatment. Conclusions: Involuntary rhythmic or non-rhythmic movements are a primary clinical feature of HT. A differential diagnosis of epilepsy and HT can be achieved through neurophysiological monitoring, avoiding the overuse of antiepileptic drugs. Symptoms can be alleviated with levodopa intervention.

Metaphoric language in the differential diagnosis of epilepsy and psychogenic non-epileptic seizures: Time to move forward

Conversation analysis (CA) to identify metaphoric language (ML) has been proposed as a tool for the differential diagnosis of epileptic (ES) and psychogenic nonepileptic seizures (PNES). However, the clinical relevance of metaphoric conceptualizations is not clearly defined. The current study aims to investigate the ML utilized by individuals with ES and PNES in a pulled multi-country sample. Two blinded researchers examined the transcripts and videos of 54 interviews of individuals (n = 29, Italy; n = 11, USA; n = 14, Russia) with ES and PNES, identifying the patient-seizure relationship representative of the patient's internal experience. The diagnoses were based on video-EEG. Metaphors were classified as “Space/place”, “External force”, “Voluntary action”, and “Other”. A total of 175 metaphors were identified. No differences between individuals with ES and PNES were found in metaphoric occurrence (χ2 (1, N = 54) = 0.07; p = 0.74). No differences were identified when comparing the types of metaphors utilized by participants with ES and those with PNES. Patients with PNES and ES did not demonstrate differences in terms of occurrence and categories in ML. Therefore, researchers and clinicians should carefully consider the use of metaphor conceptualizations for diagnostic purposes.

Can immature granulocyte (IG), an inflammatory marker, be used in the differential diagnosis of epilepsy and non-epileptic psychogenic seizure?

Can immature granulocyte (IG), an inflammatory marker, be used in the differential diagnosis of epilepsy and non-epileptic psychogenic seizure?

Four Turkish families with hyperekplexia: A missense mutation and the exon 1–7 deletion in the GLRA1 gene

BackgroundHyperekplexia is a disease that progresses with excessive startle attacks and is included in the differential diagnosis of epilepsy and many movement disorders. MethodsThe WES results were validated in available family members by Sanger sequencing, or in the case of deletion, PCR followed by agarose gel electrophoresis was performed. ResultsWES analysis revealed the previously reported homozygous c.277C>T p.Arg93Trp variant in the GLRA1 gene (ENST00000455880.2) in Family 1. In all other three families, the previously reported homozygous deletion of exons 1–7 of the GLRA1 gene was identified using CNV analysis based on the WES data. ConclusionsThe homozygous exon1-7 deletion has been described several times in different populations and may be a founder mutation in the Kurdish people in Turkey. The family with Arg93Trp variant stems from the Black Sea region of Turkey where close consanguinity is common. These analyses are important to provide genetic counseling to families and for a better understanding of the pathophysiology of the disease.

The Importance of Long-Term Video Electroencephalography Monitoring in the Differential Diagnosis of Epilepsy in Children.

Objective: Epilepsy is a condition in which abnormal, recurring, and excessive neuronal discharges caused by many different disorders in the central nervous system are observed. The rate of detecting epileptiform activity in the first interictal electroencephalography (EEG) of patients with epilepsy is around 40%, even when routine activation methods are applied. Video recordings simultaneously with EEG recordings enable the establishment of correlations between abnormalities.Patients and methods: The long-term video-EEG monitoring (VEM) reports and images of 87 patients hospitalized in the video EEG service in the Pediatric Neurology Clinic of İnönü University between 2016 and 2020 were retrospectively analyzed in this study. Demographic information of the patients, such as age, gender, diagnosis/history, and length of hospital stay, was analyzed.Results: A total of 87 patients were included in the study. Of the patients, 54 (62.1%) were male and 33 (37.9%) were female. The mean age was 107.57 ± 64.40 months. While 10 (11.5%) patients followed up with non-epileptic paroxysmal events (NEPE) were taking antiepileptic drugs (AEDs), AED treatments were discontinued after VEM. The diagnosis of 18 (20.69%) patients changed after VEM. The medications of 27 (31%) patients who took AEDs before VEM were discontinued after VEM. During VEM, sleep movement, psychogenic seizures, infantile masturbation, and tic disorder were observed in 19 (41.3%), 17 (36.9%), three (6.5%), and three (6.5%) patients, respectively.Conclusion: In conclusion, VEM is the gold standard diagnostic method used to distinguish between epilepsy and NEPEs. After VEM, the clinical diagnosis of patients can change, and unnecessary drug administration may be prevented. Psychogenic nonepileptic seizures and NEPEs are common in the pediatric population; however, they are often overlooked.

How to do things with words: Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, …) seizures

Amongst the most important conditions in the differential diagnosis of epilepsy is the one that manifests as paroxysms of altered behaviour, awareness, sensation or sense of bodily control in ways that often resemble epileptic seizures, but without the abnormal excessive or synchronous electrical activity in the brain that defines these. Despite this importance, there remains little agreement – and frequent debate – on what to call this condition, known inter alia as psychogenic non-epileptic seizures (PNES), dissociative seizures (DS), functional seizures (FS), non-epileptic attack disorder (NEAD), pseudoseizures, conversion disorder with seizures, and by many other labels besides. This choice of terminology is not merely academic – it affects patients’ response to and understanding of their diagnosis, and their ability to navigate health care systems.This paper summarises two recent discussions hosted by the American Epilepsy Society and Functional Neurological Disorders Society on the naming of this condition. These discussions are conceptualised as the initial step of an exploration of whether it might be possible to build consensus for a new diagnostic label.

Is the differential diagnosis of epilepsy and psychogenic nonepileptic seizures possible by assessing the neutrophil/lymphocyte ratio?

IntroductionThe neutrophil-to-lymphocyte ratio (NLR), which can be calculated directly from the complete blood count, is a parameter that can be accepted as an indicator of systemic inflammation. In this study, we tried to distinguish seizures from pseudo-seizures by evaluating the NLR value in the pre- and post-seizure period in epilepsy and psychogenic nonepileptic seizures (PNES). Material and methodOf the 50 patients included in our study, 36 had epilepsy and 14 had PNES. Comparison of pre- and post-seizure values of leukocyte, neutrophil, and NLR values and heart rate were made between focal, generalized onset seizures, and PNES. The pre- and post-seizure NLR was assessed for each group. ResultsThe number of leukocytes and neutrophils determined after the seizure was significantly higher in the group with generalized onset seizures compared to the PNES group. When the pre- and post-seizure leukocyte counts were examined in the generalized onset seizure group, it was observed that the post-seizure leukocyte count was significantly higher (p: <0.001). In our study, there were no differences in the ictal and postictal heart rates between the PNES and epilepsy groups, unlike previous studies. We found that the ictal heart rate was statistically higher than the preictal heart rate in the epilepsy group, as expected, but the differences in heart rate between PNES and epilepsy did not separate the groups in a meaningful way. ConclusionAs a result of these examinations, we observed that patients with epilepsy with generalized and focal onset seizures had a significantly higher number of leukocytes in their post-seizure blood. However, pre- and post-seizure NLR could not help us, within this group of patients, to separate PNES from epileptic seizures.

Gratification phenomena in children: a report of nineteen children and review of the literature

Background: Gratification phenomena (GP) are self-stimulatory behavior and also called as infantile masturbation. This phenomenon is especially seen in early childhood. GP is often misdiagnosed as epilepsy, dystonia, urinary tract infection or infantile colic resulting in numerous investigations and treatment because of variable behaviors during this event.Methods: This study aimed to describe the features of GP, so that clinicians can better recognize this condition, to prevent unnecessary evaluations, and provide appropriate guidance to parents. This study is a prospective observational study, conducted in patients with GP between March 2019 and November 2020. GP was diagnosed on the basis of history, eyewitness account and video recording of the eventResults: During the study period, 19 children were diagnosed with GP. Out of 19, 17(89.4%) children were females. The mean age at onset was 17months (range 5-36months). The mean age at diagnosis was 20 months (range 8-47months). The mean frequency of events was 4/day (range 1-12/day). A typical GP was seen in 12 of 19 (63.15%) children. At the time of referral, 31% of children were diagnosed with epilepsy and 26% of children were diagnosed with infantile colic. During follow up period, GP was subsided within 4-12 months after the initial visit.Conclusions: A GP, otherwise called infantile masturbation, is an important consideration in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. A detailed history and video recording of events often prevents unnecessary investigations and treatments.

Differential diagnosis of epilepsy and movement disorders

Резюме. Диагностика пароксизмальных состояний в неврологии — одна из самых сложных проблем. Особые трудности вызывает дифференциальная диагностика эпилептических и неэпилептических пароксизмальных нарушений ввиду отсутствия абсолютно достоверных клинических маркеров заболевания в межпароксизмальный период, не всегда достаточной информативности инструментальных методов исследования и недостаточной осведомленности врачей. Неэпилептические пароксизмальные нарушения ошибочно диагностируют как эпилепсию в 20–30% случаев даже в медицинских центрах третьего уровня. Ложная положительная диагностика эпилепсии имеет место в 2–71% случаев. Двигательные нарушения, характеризующиеся внезапными преходящими эпизодами патологической непроизвольной двигательной активности, такие как хорея, атетоз, неэпилептические миоклонии, дистония, пароксизмальная дискинезия, нарушение координации произвольных двигательных актов или сочетанные нарушения координации и непроизвольной двигательной активности (пароксизмальная атаксия), представляют значительные диагностические трудности даже для высококвалифицированных специалистов. Нет абсолютно патогномоничных признаков эпилептических и неэпилептических припадков. В статье приведены основные клинические и нейрофизиологические критерии дифференциальной диагностики эпилепсии и ряда двигательных нарушений. Лечебная тактика больных с эпилептическими приступами, которые должны быть дифференцированными с пароксизмальными двигательными нарушениями, имеет ряд особенностей. После установления диагноза «эпилепсия» назначают противоэпилептические препараты широкого спектра действия, не оказывающие негативного влияния на когнитивные функции и не требующие длительного титрования дозы. В таких случаях препаратом выбора может быть леветирацетам, который эффективен при большинстве эпилептических припадков, может эффективно применяться во взрослой и детской практике, не вызывает аггравации припадков, имеет минимальные побочные действия, может быть назначен сразу в терапевтической дозе, кроме того, эффективен при ряде двигательных нарушений и при сочетании эпилепсии с двигательными нарушениями.

Self-gratification Habits among Children Under Five Years of Age: A Prospective Cohort Study

Introduction: Self-gratification or masturbation is a normal sexual behaviour; however, masturbation in childhood is less commonly addressed in literature. Aim: To describe the clinical profile of the children diagnosed with self-gratification condition. Materials and Methods: This prospective cohort study recruited all cases diagnosed to have the self-gratification condition presenting to the outpatient clinic in the Department of Paediatric Medicine, Burdwan Medical College, Burdwan, West Bengal, India during the period- January 2014 to December 2019. Diagnosis was made from history, home videotapes and sometimes by direct observation of the act during hospital stay. All relevant data pertaining to demographic characteristics, clinical presentation, investigations and treatment were collected in case sheets and were analysed by simple descriptive statistics. Results: Fifty-four patients were diagnosed to have the condition. Among them, 29 (53.70%) were girls and 25 (46.30%) were boys. The mean age at first symptoms was 20.98±9.31 months (range 3 months to 3 years 4 months). The average age at diagnosis was 26.16±11.35 months (varied from 4 months to 3 years 11 months). The mean frequency of events was 10.31±5.10 times per week, and the mean duration was 9.83±5.98 minutes. Events occurred mostly when children were left alone and bored (n=34, 62.97%). Usual presentations were: rocking in prone position (n=24, 44.44%), intermittent dystonic posturing of the crossed legs (n=23, 42.59%), direct genital manipulation (n=3, 5.56%) and others (n=4, 7.40%)). Two children had been previously misdiagnosed as having definite epilepsy. In 51 cases (94.44%) home videos were available which served as invaluable tools allowing confident diagnosis. Results of urine and stool examination were normal. MRI and EEG performed on two children with suspected epilepsy were reported normal, and antiepileptic drugs were stopped in both. Sixteen children (29.63%) were sent for behavioural therapy and all of them responded well in next one year. Conclusion: Gratification habits are not uncommon in children and should be considered in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Home video recording of these actions can be a very influential mean to help in diagnosis and to avoid needless investigations and treatments.

S16. The occurrence of nonepileptic events in children with intractable epilepsy: Findings from a single centre prospective audit

Introduction Nonepileptic events are known to occur in persons with epilepsy, which could have a bearing on patient outcomes for those undergoing epilepsy surgery. Methods Over an 8 year period (2008–2017) 264 consecutive pediatric patients (age range 5 months to 17 years, mean 10.4 years, 145 males) were enrolled in our Children’s Epilepsy Surgery Service. Patients had been diagnosed with epilepsy on clinical and routine EEG grounds, and were deemed pharmaco-resistant based on their failure to respond to 2 or more anti-epileptic drugs at adequate doses for 6 months or more. As part of their pre-surgical work-up patients were admitted for 3–5 days of Video EEG (VEEG) monitoring to characterize their seizures, according to a standard recording protocol ( Pressler et al., 2017 ). Results We prospectively identified epileptic seizures in 224 children (85%), confirming the clinical diagnosis, and/or stereotypic nonepileptic events (NEE) without electrographic changes in 129 (49%). We excluded the usual paroxysmal events that can mimic seizures, including syncope, parasomnias, cardiac arrhythmia, and migraine. The videoed NEE were reviewed when appropriate with the patient’s parents or carers; confirmed as being habitual and that they had been erroneously attributed to ictal activity.This gave a VEEG-confirmed co-existence of epileptic seizures and NEE of 41%, compared to 10–50% in the Non-Epileptic Attack Disorder literature ( Francis and Baker, 1999 ). Conclusion We conclude that it is common to encounter concurrent epileptic and nonepileptic events in pediatric patients with medically intractable epilepsy. Our figure of 41% is higher than the reported occurrence of psychogenic nonepileptic seizures (PNES) in recent retrospective VEEG series of pediatric populations, when the clinical question was the differential diagnosis of epilepsy (33%) ( Szabo et al., 2012 ), including pre-surgical evaluations (19%) ( Riquet et al., 2011 ). Whilst not a contra-indication to epilepsy surgery per se the co-existence of NEE (or PNES) should be borne in mind when managing and counselling pediatric patients and their family or carers.

Serum Prolactin Level in Children with Febrile Seizure and Epileptic Seizure; Comparative Study

Introduction: Transient hyperprolactinaemia has been reported to follow unprovoked seizures, a finding proposed to be useful in the differential diagnosis of epilepsy. On this basis we conducted a study with an objective to compare the postictal serum prolactin level in children with febrile seizures (FS) and epileptic seizures (ES) to evaluate, whether serum prolactin (PL) could be used a predictor in the diagnosis of ES.Material and Methods: This was a prospective comparative study was conducted on 52 children (26 in febrile seizures group and 26 in epileptic seizure group) in the age group of six months to five years. Children with CNS infection, developmental delay, structural CNS defects or neurological abnormality, metabolic disorders and those on drugs, known to have altered serum prolactin level were excluded. Blood for estimation of serum prolactin was collected within 180 minutes of occurrence of seizure. Level of serum prolactin was quantitatively assayed by chemiluminescence method and the levels were considered high, if values were greater than 23 ng/ml, which is the upper limit of normal for all age groups and both sex.Results: The mean serum prolactin level in epileptic seizures group was 25 ng/ml and that of febrile seizures group was 10.72 ng/ml. High level of serum prolactin was noted in 17 children (77.2%) with GTCS and 3 children (75%) with CPS. None of the children with febrile seizures had significant raise in the level of serum prolactin.Conclusion: There is a significant rise in serum prolactin level in children with epileptic seizures compared to febrile seizures, if measured within 3 hours of occurrence of seizures. Thus, the post-ictal serum prolactin level can be used as an additional investigation to diagnose or predict epileptic seizures in children.

Diagnosis of non-epileptic paroxysmal disorders and epileptic seizures

Non-epileptic paroxysmal disorders may clinically manifest in a similar way to epileptic seizures and have to be considered in the differential diagnosis of epilepsy. Syncope, non-epileptic psychogenic seizures, paroxysmal movement disorders, migraine, transient ischemic attacks and parasomnia constitute the major differential diagnoses. Ameticulous history and a third party description are useful for the differential diagnosis. Neurological, psychiatric and cardiological examinations are required for the correct differential diagnosis. The interictal electroencephalogram (EEG), which is normal in non-epileptic patients, is frequently normal in epileptic patients at the onset of seizures, but reaches ahigh sensitivity after repeated recordings. In equivocal cases EEG video monitoring and in the case of suspected cardiac asystole, event recorders are useful diagnostic tools.

SPECIFIC FEATURES OF ELECTROENCEPHALOGRAPHIC PAROXYSMAL ACTIVITY REGISTRATION IN OLD AGE GROUP PATIENTS

The differential diagnosis of epilepsy and other paroxysmal states mimicking this condition is very important in the daily activity of a neurologist (an epileptologist) since diagnostic accuracy directly ensures the efficacy and safety of treatment. According the data available in the literature, both overdiagnosis of epilepsy (20–25 % of all new diagnosed cases) and its underdiagnosis (as high as 10 %) are frequent diagnostic errors. Such errors are most commonly related to the misinterpretation of electrophysiological evidence in both young patients (in whom paroxysmal phenomena are a result of functional immaturity of brain structures) and elderly patients (in whom paroxysmal activity is a consequence of the development of degenerative processes in the neurons). Objective: to show examples of electroencephalographic (EEG) paroxysmal activity in old age group patients suffering from non-epileptic paroxysms. Now EEG investigation is a highly sensitive technique that requires a physician’s knowledge of neuroanatomy and neurophysiology to correct interpretation of the findings. Non-epileptiform paroxysmal events may be detected not only in children who have immature cerebral cortical neurons and median brainstem structures, but also in the elderly in whom their emergence is due to the development of degenerative processes in the neurons. The similarity of these phenomena with typical EEG epileptiform patterns is not coincidental. The basis for their occurrence is the similar mechanism for glutamate excitotoxicity, but, unlike epilepsy, which is triggered by ischemic and hypoxic processes, rather than by the exhausted reserve abilities of nerve cells during overstimulation. Therefore the detection of this pathological EEG paroxysmal activity calls for careful differential diagnosis.

NON EPILEPTIC PAROXYSMAL EVENTS IMITATING EPILEPSY IN CHILDREN

Differential diagnosis of epileptic seizures with non epileptic paroxysmal events often have serious difficulties. The most various states which are observed at somatic, neurologic, psychiatric disorders and even at healthy children imitate an epilepsy. Objective. Evaluation of reliability of the diagnosis “epilepsy” in patients referred to the epilepsy center. Material and methods. 2015 patients referred to our epilepsy center for evaluation and treatment for 3-year period. Age from 0 to 21 years. Methods of diagnosis: clinical examination, video-EEG monitoring (VEEG) of 6 to 120 hours, brain MRI. Results. The diagnosis of “epilepsy” was reliably confirmed in 1552 patients (77%). Among these, 101 (6,5%) patients were diagnosed late (later than 6 months from the onset with seizures frequency more often than 1 time per month). At 463 (23%) patients overdiagnosis has been established – the diagnosis epilepsy with the current seizures was established unreasonably. Among them we have identified the following 3 groups: healthy children – 57 patients (12.3%); somatic and neurological disorders – 323 patients (70%); psychogenic non-epileptic seizures (PNES) – 83 patients (18%). The most frequently seizures was imitated by hyperkinetic movement disorders – 40.4% (187 patients), including paroxysmal dyskinesia, hyperkinetic eye movements, pathological nonepileptic myoclonus, jitteriness, shuddering attacks, benign neonatal sleep myoclonus, tics, hyperekplexia, benign myoclonus of early infancy, benign paroxysmal torticollis, spasmus nutans. Among the frequent reasons of over-diagnosis of epilepsy were also parasomnias and PNES. Conclusions. The most frequent diagnostic errors were linked to the lack of objective information about the nature of paroxysms and misinterpretation of the EEG. VEEG is the most valuable tool in the differential diagnosis of epilepsy

P89. Differential diagnosis between epilepsy and parasomnia may be difficult even on 10–20 video-EEG

Sleep related attacks of bizarre complex movements may be due to either epilepsy or non-REM parasomnia. Differential diagnosis can be especially difficult in mentally retarded patients due to lack of detailed medical history and presence of epilepsy risk factors such as brain lesions. We present the case of a 19 year-old male with history of preterm birth, perinatal intracerebral hemorrhage, and post-hemorrhagic hydrocephalus. His parents reported up to 20 attacks per night characterized by startle from sleep, fearful expression in his eyes, grabbing hold of the bedframe, body rocking, and groaning, each episode lasting between 10 and 30 s. Several standard EEGs were normal. Cranial computed tomography (CT) scan showed a ventriculo-peritoneal shunt catheter in place. He was diagnosed with parasomnia following standard polysomnography in an external sleep laboratory. In our institution, polysomnography and 10–20 video EEG monitoring were performed for four nights, and 13 of the habitual attacks were recorded. All attacks occurred out of sleep with six attacks occurring from slow-wave sleep (N3) and seven occurring out of light sleep (N2). All but one attack were lacking an ictal EEG change, only one event was associated with rhythmic evolving theta in the left frontal region lasting for a few seconds. Tachykardia of up to 170 beats per minute was seen in all events. Video review revealed that the sequence of clinical features was extremely stereotypical and monomorphic across all 13 events. Interictal EEG was completely normal during the awake stage as well as during sleep in the first and second nights. Only in nights three and four, interictal sleep EEG revealed several spikes in the left frontal region. We diagnosed left frontal lobe epilepsy with exclusively sleep-related hypermotor seizures and stared the patient on anticonvulsant medication. This case demonstrates that the differential diagnosis of epilepsy versus Non-REM parasomnia may be difficult even with 10–20 video EEG. The vast majority of seizures (or all) may lack an ictal EEG pattern, and interictal epileptiform spikes or sharp waves may be very infrequent or absent. Short events with a very stereotypic sequence of clinical features as well as attacks arising from light sleep (N2) support the diagnosis of epilepsy. One or two nights of polysomnography – even with an extended 10–20 EEG montage – may not be sufficient to differentiate parasomnia from epileptic seizures.

Contribution of electroencephalography in epileptology : Senegalese experience

Epilepsy is a public health problem. Its diagnosis is clinical, but it often requires additional investigations including electroencephalogram. Electroencephalogram plays a fundamental role. We report in this paper our experience on contribution of electroencephalogram in epileptology. This work is based on data from the literature in general, but also from a series of publications by our research team since 2004. Since then we have indeed highlight, from a series of articles and communications, the key role of this exam in the context of partial seizures’ explo- ration, in relationship between sleep and epilepsy, in syndromic diagnosis of childhood epilepsy, in phenotypic study of familial epilepsy, in differential diagnosis of epilepsy and even treatment.

EHMTI-0286. Hemicrania epileptica: case report

Headache occurring during partial seizure, ipsilateral to the epileptic discharge, and remitting immediately soon after the seizures has terminated, is mentioned in IHS Classification 3rd edition (7.6.1). We here report the case of a misunderstood partial epilepsy, headache being considered the main problem. A fifty years old woman presented with a ten days history of stabbing left lateralized headache. The attacks were short-lasting (<3 minutes), at least forty or more every day, neuralgiform without conjunctival injection or tearing, but always associated with elementary hallucination (a bright light) in the right hemifield. She had a a history of very severe head trauma at age twenty-one, with left hematoma evacuation, followed by hydrocephalus, installation of ventriculo-peritoneal shunt complicated by meningitis. She had the same headache attacks at age thirty for a period of three months. She took several analgesic preparation every day with benefit on headache but not on right sided hallucinations. EEG showed left spikes discharges on the left temporo-occipital regions occurring during the headache with hallucinations attacks and remitting immediately after the seizures has terminated. CT demonstrated left porencephalic cavity, ex vacuo dilatation of left lateral ventricle, left temporo-parietal fracture, ventricolo-peritoneal catheter in right lateral ventricle. The seizures remitted with antiepileptic therapy (levetiracetam 500 mg twice daily). Our case report demostrates the importance of considering the differential diagnosis of epilepsy in stabbing headache even when analgesic sensitive. No conflict of interest.

Psychogenic non epileptic seizures on differential diagnosis of epilepsy

Psychogenic non epileptic seizures on differential diagnosis of epilepsy

Eficacia de la monitorización videoelectroencefalográfica prolongada con protocolo específico de activación cerebral en el diagnóstico diferencial de la epilepsia

ObjectiveTo analyze the usefulness of a specific EEG activation protocol during video-EEG (VEEG) monitoring in the differential diagnosis of epilepsy. MethodSince January 2009, 181 patients underwent two different EEG activation protocols during VEEG monitoring in the Epilepsy Unit of Hospital Ruber International. One protocol (the “standard protocol”) included hyperventilation and intermittent photo-stimulation while the other (“specific protocol”) consisted of potentially provocative cognitive tasks (reading, writing, calculation and spatial construction). Both protocols where supervised by specialized epilepsy nurses, who assessed the correct performance of these activation tasks. ResultsAfter applying the two protocols during VEEG monitoring a diagnosis of focal epilepsy (FE) was achieved in 144 out of 181 patients and idiopathic generalized epilepsy (IGE) in 37 out of 181. The specific activation protocol induced epileptiform activity (EA) or seizures in 34 out of 37 patients in the IGE group and in none in the FE group. Fifteen of our IGE patients had a wrong diagnosis of FE before being evaluated with VEEG using the specific protocol, and the wrong diagnoses could be corrected after the study. In three patients of the IGE group the VEEG was normal. ConclusionsOur results suggest that the application of these specific activation techniques that included cognitive tasks is a simple and useful tool in the diagnosis of epilepsy.