Epilepsy: Or something else? Differential Diagnosis

Respiratory System (J00-J99)

  • Specifically, in children:
    • Respiratory arrest

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Metabolic derailments such as those associated with excessive alcohol consumption (“blackout”).

Cardiovascular system (I00-I99).

  • Apoplexy (stroke)
    • Especially in children
    • Epileptic seizures occur as the first symptom in 2-4% of cerebral ischemias and cerebral hemorrhages. [Epilepsy is a “stroke chameleon,” meaning it suggests another condition that is actually apoplexy]
  • Cerebral ischemia (circulatory disturbances in the brain).

Infectious and parasitic diseases (A00-B99).

  • Infections, without further specification

Neoplasms – tumor diseases (C00-D48).

  • Paraneoplastic neurologic symptoms – focal epilepsy, neuropathy, cerebellar degeneration, limbic encephalitis, opsoclonus-myoclonus ataxia, polyneuropathy (autonomic, sensory, sensorimotor), extrapyramidal motor syndromes – in tumors of the esophagus (esophagus) and upper airway.

Ears – mastoid process (H60-H95).

  • Specifically in children:
    • Vertigo (dizziness)

Psyche – nervous system (F00-F99; G00-G99)

  • Movement disorders such as tics – irregularly repeated rapid movements or twitching.
  • Substance abuse
  • Insomnia (sleep disorders)
  • Migraine with aura
    • Migraine with typical visual disturbances, photophobia, headache and nausea.
    • Possible neurological deficits with dysarthria (disorders of speech), paresthesias (sensory disturbances) or paralysis can complicate the distinction from epilepsy
  • Paroxysmal movement disorders (seizure-like).
    • Involuntary episodic and short-lasting ataxias (gait disorder), dystonias (disorder of muscle tension), dyskinesias (disorders of postural and movement control), ballisms (movement disorder with sudden, slingshot movements), or choreatic symptoms (involuntary, irregular, rapid, brief muscle contractions with movement effect)
    • Occurrence always without changes in consciousness
  • Mental illness, unspecified
  • Psychogenic nonepileptic seizures (PNEA)* .
    • Uncontrolled and wild-looking movements with eyes closed to some extent “squeezed” shut
    • vegetative symptoms as in an epileptic seizure (defecation/urination, increased salivation, cyanosis) occur less frequently and
      • Have, in contrast to epileptic seizures, no electrophysiological correlate in the EEG.
    • Seizure can last from seconds to hours!
  • REM sleep behavior disorders – parasomnia (behavioral abnormalities that occur predominantly from sleep), in which vivid and often frightening dreams are translated into simple and even complex movements during REM sleep.
  • Specifically in children:
    • Nocturnal anxiety attacks
    • Pavor nocturnus (night terrors)
    • Sleepwalking (somnambulism)
  • Behavioral disorders (e.g., tics).

Injuries, poisonings, and certain other consequences of external causes (S00-T98).

  • Intoxications (poisonings)
  • Traumatic brain injury (TBI)
  • Trauma (injuries)

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Febrile convulsion, prolonged (thus complicated) (approximately 30% of cases in children with status epilepticus).
  • Syncope* – short-lasting fainting due to an undersupply of the brain with oxygen; mainly reflex syncope (eg, vasovagal syncope; trigger: standing, coughing) or orthostatic syncope (trigger: sitting up), duration 1-30 seconds; possibly also ventricular tachycardia!Note: Myoclonias (rapid involuntary muscle twitching) or tonizations occur here predominantly multifocal (multiple seizure foci).

Environmental stress – intoxications (poisoning).

  • Alcohol poisoning

* Ca.90% of all misdiagnoses