Differential Diagnosis Of Seizures Research Articles

Epilepsy and Related Disorders

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. This review contains 7 figures, 17 tables and 38 references Keywords: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

Epilepsy and Related Disorders

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. This review contains 7 figures, 17 tables and 38 references Keywords: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

Epilepsy and Related Disorders

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. This review contains 7 figures, 17 tables and 38 references Keywords: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

Epilepsy and Related Disorders

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. This review contains 7 figures, 17 tables and 38 references Keywords: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

Epilepsy and Related Disorders

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. This review contains 7 figures, 17 tables and 38 references Keywords: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

Differential Diagnosis of Seizure and Syncope by the Means of Biochemical Markers in Emergency Department Patients

Background:Seizure and syncope have similar clinical symptoms but different etiologies. Hence, differential diagnosis is crucial prior to intervention. This study evaluates the diagnostic importance of neuron specific enolase (NSE), creatine phosphokinase (CPK), and serum lactate dehydrogenase (LDH) for admitting patients with seizure medical history to emergency department (ED) in order for differential diagnosis between syncope and seizure.Methods:Patients with a short-lasting loss of consciousness admitted to the ED were recruited. All patients with a short-lasting loss of consciousness were eligible and EEG was conducted several times and was taken over a long period. Patients were then divided into two groups of seizure and syncope. The biochemical markers levels of all the eligible patients were measured by a reputable laboratory.Results:In order to define specificity and sensitivity of different levels of biomarkers and the optimal cut-off points, ROC curves for each biomarker of syncope and seizure patients admitted to ED were performed. AUC for NSE, CPK, and LDH were 0.973 ± 0.023, 0.827 ± 0.047, and 0.836 ± 0.043 respectively in 95% confidence level. Cut-off points for NSE, CPK, and LDH were determined 25.12, 218.09, and 193.88 respectively.Conclusions:It was concluded that NSE, CPK and LDH levels were different significantly in seizure patients compared to syncope ones. The seizure group showed an increase in NSE, CPK and LDH level.

Seizures in a Term Newborn.

Seizures in a Term Newborn.

Phenotypic and Genotypic Spectrum of Glucose Transporter-1 Deficiency Syndrome.

Glucose Transporter-1 (GLUT1) Deficiency Syndrome (GLUT1DS) is caused by defective transport of glucose across the blood-brain barrier into brain cells resulting in hypoglycorrhachia due to the heterozygous pathogenic variants in SLC2A1. We report on the phenotypic spectrum of patients with pediatric GLUT1DS as well as their diagnostic methods from a single center in Canada. We reviewed patient charts for clinical features, biochemical and molecular genetic investigations, neuroimaging, treatment modalities, and outcomes of patients with GLUT1DS at our institution. There were 13 patients. The most common initial symptom was seizures, with the most common seizure type being absence seizures (85%). Seventy-seven percent of the patients had movement disorders, and dystonia and ataxia were the most common movement disorders. Fifty-four percent of the patients did not have a history of developmental delay during their initial presentation, whereas all patients had developmental delay, intellectual disability, or cognitive dysfunction during their follow-up. All patients had a pathogenic or likely pathogenic variant in SLC2A1 and missense variants were the most common variant type. We present 13 patients with GLUT1DS in the pediatric patient population. Atypical clinical features such as hemiplegia and hemiplegic migraine were present in an infant; there was a high prevalence of absence seizures and movement disorders in our patient population. We report an increased number of patients with GLUT1DS since the introduction of next-generation sequencing in the clinical settings. We believe that GLUT1DS should be included in the differential diagnosis of seizures, movement disorders, and hemiplegic migraine.

Problems of differential diagnosis of acute symptomatic infectious seizures and epilepsy in children

Viral encephalitis, its complications and the newly diagnosed epilepsy in children require a complex approach to the differential diagnosis using laboratory and instrumental examinations. Possibilities of MRI in the differential diagnosis of seizures in children and in detection of ischemic-hypoxic and metabolic disorders in the suspected epileptic focus are demonstrated in the clinical observation.

Secondary Fahr's Disease: A Consequence of Post-Thyroidectomy Hypoparathyroidism.

ObjectiveThe objective of this case report is to emphasize the importance of considering uncommon conditions like Fahr’s disease in the differential diagnosis of seizures and cognitive impairment, especially in patients with a history of thyroidectomy.Material and MethodsA 56-year-old woman who had undergone subtotal thyroidectomy 25 years previously presented with movement disorder and cognitive impairment secondary to hypoparathyroidism. A CT scan of the brain showed pathognomonic bilateral calcification in the basal ganglia, thalamus and cerebellar nuclei.ResultThe patient was diagnosed with Fahr’s disease caused by post-thyroidectomy hypoparathyroidism and successfully managed with oral calcium, carbidopa/levodopa and haloperidol.ConclusionWe recommend the routine use of CT scanning in the long-term follow-up of post-thyroidectomy patients.LEARNING POINTSCT scans of the brain should be routinely carried out as part of long-term follow-up after thyroidectomy.Cognitive impairment and/or seizures should also be investigated using brain imaging.Taking a detailed history is a cornerstone of diagnosis in internal medicine.

Brain Tumor in Differential Diagnosis of Seizures in Puerperium: Case Report

Convulsive crisis is a transient disturbance of cerebral function, and the etiology of which may be manifold. Its clarification is essential for establishing adequate therapy and seizure control. In the pregnancy-puerperal cycle, eclampsia is the most common cause of it, but brain tumor, epilepsy and other disorders are part of the differential diagnosis. We report a case of seizure triggered by tumor in a primigest, 22 years old, at 38 weeks’ gestation with premature rupture of membranes. Cesarean section was performed due to non-reassuring fetal condition. On the second day of puerperium, she presented recurrent episodes of generalized tonic-clonic seizures and elevated blood pressure. She received magnesium sulfate for 24 hours and persisted with severe headache. Magnetic resonance imaging of the brain showed an expansive lesion in the left frontoparietal region. The patient underwent intracranial microsurgery on the eighth day after cesarean section, with complete resection of the lesion and anatomopathological diagnosis of schwannoma. She went through good postoperative evolution, without neurological deficits, and stayed on phenobarbital, with no seizures until 6 months of follow-up. From the case we conclude that although the first diagnosis in pregnant or puerperal women with seizures should be eclampsia, there are other causes, such as brain tumor and Posterior Reversible Encephalopathy Syndrome (PRES). Careful evaluation is required, especially in refractory cases and not responding to usual treatment.

A Case Presentation on Seizure Disorder (Epilepsy during Pregnancy)

AbstractSeizures during pregnancy complicate <1% of all gestations; however, they are associated with increased adverse maternal and perinatal outcomes (acute and long term). The differential diagnosis of seizures in pregnancy is extensive. Determining the underlying etiology is crucial in the management of these patients. Medical providers caring for pregnant women should be educated about possible etiologies of seizures during pregnancy and the importance of prompt management of these women in a timely fashion. Evaluation and management should be performed in a stepwise fashion and may require a multidisciplinary approach with other specialties such as neurology. Objective: The objective of this article is to increase awareness and to provide a stepwise approach toward the diagnosis and management of pregnancies complicated by seizures.

Non-epileptic attacks – A common diagnostic challenge

Misdiagnosis of children and adolescents with epilepsy is common and it is estimated to be 20–35% of patients diagnosed with epilepsy who are seen at epilepsy centers. The differential diagnosis of seizures is broader in children than in adults, with many nonepileptic but nonpsychogenic conditions to be considered. Physiological and organic events (syncope, hypoglycemia, panic attacks, paroxysmal movement disorders) predominate in infants and young children. Psychiatric disorders (psychogenic non-epileptic attacks) become more common in later childhood and adolescence. Other diagnoses, including parasomnias, self-stimulating behaviors (infantile masturbation), stereotyped mannerisms, hypnic jerks, parasomnias, tics, gastroesophageal reflux with posturing or laryngospasm, arousals, shuddering attacks, breath-holding spells (cyanotic infantile syncope) can be erroneously interpreted as seizures. Diagnosis of seizures should be clinical. Most errors in diagnosis are made because the EEG is overread as abnormal and is interpreted outside of the clinical context. Ambulatory EEGs can contribute to the diagnosis by recording the habitual episode and documenting the absence of EEG changes. The use of prolactin has little value. The gold standard for diagnosis of non-epileptic events is video/EEG monitoring. It is indicated in all patients who continue to have frequent seizures despite antiepileptics.

Epilepsy and Niemann Pick C disease

Niemann-Pick disease type C (NPC) is an autosomal recessive, neurovisceral lipid storage disorder. Estimated to occur in one case every 120,000 live births. Approximately 95% of patients have mutations in the Niemann-Pick disease, type C1 (NPC1) gene and 5% in the Niemann-Pick disease, type C2 (NPC2) gene. It is a highly heterogeneous disease, characterized by visceral, neurological and psychiatric manifestations. Seizures are presented as unspecific feature in 33% of NPC patients, Seizures and cataplexy have been more often recorded among late infancy and juvenile-onset cases (37-57%) than early infancy (17%) and adolescent/adult onset (6-9%). Gelastic cataplexy represent the main differential diagnosis of seizures in a patient with NPC. In the current article, the nature of seizures in NPC, other non-epileptiform seizure like events, the frequency/impact on the disease course and their response to traditional and novel therapies as well as the outcome of a literature review is presented. Patients with NPC can experience any frequency and type of seizures, with reports suggesting they are an indicator of progression of disease. Refractory seizures have been reported in pediatric and adult populations, all of them associated with visceral, neurological and/or psychiatric symptoms. Electroencephalograms have been reported with non-specific background and interictal findings. Treatment with anticonvulsants and more recent disease specific treatments as Miglustat or hydroxypropyl- -cyclodextrin have showed a variable response. Further studies are needed to elucidate specific features of NPC and epilepsy, as well as the impact of other developing specific therapies in seizure control.

Novel biochemical marker for differential diagnosis of seizure: ischemia-modified albumin

IntroductionDifferential diagnosis of seizure is critical in patients presented to emergency department (ED) with altered mental status or loss of consciousness. Although electroencephalogram is important for the diagnosis of seizures, its use in EDs is limited. The level of ischemia-modified albumin (IMA) increases in conditions of ischemic distress such as acute coronary syndrome, pulmonary embolism, and mesenteric ischemia. No studies exist in literature regarding the increase of IMA levels parallel to increased seizure activity in adults. The aim of the study was to investigate the diagnostic value of IMA in adult patients presented to ED with seizures. MethodsForty patients presented to ED with seizure, and 40 control patients of similar age and sex as the study group were enrolled in this study. Initial and fourth-hour levels of IMA and albumin were measured. Groups were compared in terms of sociodemographic data and details regarding their seizures as well as initial and fourth-hour levels of IMA. ResultsMean levels of IMA were 61.5 IU/mL and 18.5 IU/mL (P < .001) initially and 56.7 IU/mL and 15.4 IU/mL (P < .001) at the fourth hour; levels were higher in the study group compared with control group. Ischemia-modified albumin/albumin ratios in study and control groups were 1555.3 IU/g and 462.4 IU/g (P < .001) initially and 1431.4 IU/g and 383.6 IU/g (P < .001) at the fourth hour, respectively. ConclusionBlood IMA level and IMA/albumin ratio significantly increase in adult patients who experienced seizures. Ischemia-modified albumin may be considered as a useful biomarker in the differential diagnosis of seizure.

The Answer Lies in the Formula? Seizures in a Young Infant

A case of a previously healthy 10-week-old female who presented with a generalized tonic-clonic seizure is reviewed and discussed. Presenting signs and symptoms included fever, tachycardia, hypertension, dilated pupils, diaphoretic skin, and an altered mental status, consistent with a sympathomimetic ingestion. Urine drug screening and confirmatory blood testing revealed the designer methamphetamine, MDMA (Ecstasy), and methamphetamine as the causative agents. The differential diagnosis of seizures and causes of sympathomimetic toxicity are discussed.

Metoclopramide Induced Acute Dystonic Reaction in a Child: A Case Report

Metoclopramide is a dopamine receptor antagonist drug that has been used for treatment of a variety of gastrointestinal symptoms. It may also cause a variety of extrapyramidal movement disorders. Acute dystonia is a rare side effect that develops especially in children within the 1st-3rd days of metoclopramide treatment. Acute dystonias usually present themselves as buccolingual, torticollic, oculogyric, tortipelvic, and/or opisthotonic forms. A seven-yearold boy was referred to our emergency department from another hospital with the pre-diagnosis of seizure. A diagnosis of acute gastroenteritis had been made there and treatment with intravenous fluid and metoclopramide (0.5 mg/kg per day in three doses) had been started two days prior. One hour earlier, atypical limb and head movements had begun and seizure was thought to be the cause. Consequently, he was sent to our department for further evaluation. Based on the history and physical examination findings, a diagnosis of acute dystonic reaction was made and biperidene lactate (5 mg) was given. Four hours later, all symptoms had abated. In conclusion, acute dystonic reactions developing due to metoclopramide can be confused with seizures, because of physicians’ unfamiliarity with dystonic movements. Therefore, it is necessary that acute dystonic reactions be considered in differential diagnosis of seizures

Serum neuron-specific enolase level as a biomarker in differential diagnosis of seizure and syncope

Patients who experience a single generalized tonic-clonic seizure or syncope may have similar clinical symptoms, which can cause difficulty in the differential diagnosis. The aim of this study was to examine whether serum neuron-specific enolase (NSE) has diagnostic relevance as a biochemical marker for these disorders. Serum NSE levels were analyzed following a loss of consciousness in patients who were diagnosed with a seizure (n = 52) and syncope (n = 42) compared with normal controls (n = 91). NSE was 14.97 ± 7.57 ng/dl for the seizure group, 10.15 ± 3.22 ng/dl for the syncope group, and 10.03 ± 1.28 ng/dl for the control group. The seizure group showed a significantly increased serum NSE (p < 0.05) compared to the syncope and control groups. By receiver operating characteristic (ROC) curve analysis, the cut-off value with the highest diagnostic accuracy was defined as 11.5 ng/ml with a sensitivity of 0.58 and specificity of 0.91. The NSE values of the syncope and control groups showed no significant differences. Syncope may not influence diffuse brain damage. Serum NSE measurement may be a helpful test for the identification and diagnosis of a seizure rather than syncope.

Pearls: Epilepsy

Technology plays a greater and expanding role in the evaluation, diagnosis, and treatment of epilepsy and seizure disorders with the use of electroencephalography and video electroencephalography (EEG) monitoring. However, the history and clinical examination of the patient will always be the most important parts of the evaluation of patients with seizures, epilepsy, and other similar disorders. Clinical pearls for the differential diagnosis of seizures, psychogenic nonepileptic seizures, initial diagnosis of epilepsy, epilepsy evaluation, and use of anticonvulsants are provided.

MR imaging findings suggestive of posterior reversible encephalopathy syndrome in adolescents with systemic lupus erythematosus

Endothelial damage, hypertension and cytotoxic medications may serve as risk factors for the posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus. There have been few case reports of these findings in pediatric lupus patients. We describe clinical and neuroimaging findings in children and adolescents with lupus and a PRES diagnosis. We identified all clinically acquired brain MRIs of lupus patients at a tertiary care pediatric hospital (2002-2008). We reviewed clinical features, conventional MRI and diffusion-weighted imaging (DWI) findings of patients with gray- and white-matter changes suggestive of vasogenic edema and PRES. Six pediatric lupus patients presenting with seizures and altered mental status had MRI findings suggestive of PRES. In five children clinical and imaging changes were seen in conjunction with hypertension and active renal disease. MRI abnormalities were diffuse and involved frontal regions in five children. DWI changes reflected increased apparent diffusivity coefficient (unrestricted diffusion in all patients). Clinical and imaging changes significantly improved with antihypertensive and fluid management. MRI changes suggestive of vasogenic edema and PRES may be seen in children with active lupus and hypertension. The differential diagnosis of seizures and altered mental status should include PRES in children, as it does in adults.