Chapter 4 The differential diagnosis and investigation of epilepsy
Simon Shorvon
• The differential diagnosis of epilepsy is wide. It is not uncommon for epilepsy to be misdiagnosed.
• The key to diagnosis is to obtain a good first hand witnessed account or a video of a seizure.
• The commonest conditions confused with epilepsy are syncope and non-epileptic attack disorder (NEAD; pseudoseizures). A wide range of other conditions also enter into the differential diagnosis.
• A positive electroencephalogram (EEG) is a useful confirmation of a diagnosis of epilepsy, but in new cases of epilepsy approximately 50% of routine EEGs are normal. EEG is often misinterpreted, and many patients have a misdiagnosis of epilepsy because of misinterpretation of their EEG.
• Magnetic resonance imaging (MRI) is useful for establishing the cause of epilepsy. Sensitivity is increased by tailoring the MRI sequences and scanning parameters to the clinical situation.
Part of the Oxford Neurology Library, this concise online reference highlights the importance of epilepsy, its diagnosis, the problems of misdiagnosis, and current thoughts on its pathogenesis, acute treatment and rehabilitation, in both children and adults.
Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
