Pearls: Epilepsy

 

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ABSTRACT

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.

REFERENCES

• 1 Morrell M J. Differential diagnosis of seizures.  Neurol Clin. 1993;  11(4) 737-754
  PubMedGoogle Scholar
• 2 Abboud F M. Neurocardiogenic syncope.  N Engl J Med. 1993;  328(15) 1117-1120
  CrossrefPubMedGoogle Scholar
• 3 Benbadis S R, Wolgamuth B R, Goren H, Brener S, Fouad-Tarazi F. Value of tongue biting in the diagnosis of seizures.  Arch Intern Med. 1995;  155(21) 2346-2349
  CrossrefPubMedGoogle Scholar
• 4 Benbadis S R. Tongue biting as a lateralizing sign in partial epilepsy.  Seizure. 1996;  5(3) 175-176
  CrossrefPubMedGoogle Scholar
• 5 Sazgar M, Carlen P L, Wennberg R. Panic attack semiology in right temporal lobe epilepsy.  Epileptic Disord. 2003;  5(2) 93-100
  PubMedGoogle Scholar
• 6 Alemayehu S, Bergey G K, Barry E et al.. Panic attacks as ictal manifestations of parietal lobe seizures.  Epilepsia. 1995;  36(8) 824-830
  CrossrefPubMedGoogle Scholar
• 7 LaFrance Jr W C. Psychogenic nonepileptic seizures.  Curr Opin Neurol. 2008;  21(2) 195-201
  CrossrefPubMedGoogle Scholar
• 8 Williamson P D, Spencer D D, Spencer S S, Novelly R A, Mattson R H. Complex partial seizures of frontal lobe origin.  Ann Neurol. 1985;  18(4) 497-504
  CrossrefPubMedGoogle Scholar
• 9 Chung S S, Gerber P, Kirlin K A. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures.  Neurology. 2006;  66(11) 1730-1731
  CrossrefPubMedGoogle Scholar
• 10 Syed T U, Arozullah A M, Suciu G P et al.. Do observer and self-reports of ictal eye closure predict psychogenic nonepileptic seizures?.  Epilepsia. 2008;  49(5) 898-904
  CrossrefPubMedGoogle Scholar
• 11 Vossler D G, Haltiner A M, Schepp S K et al.. Ictal stuttering: a sign suggestive of psychogenic nonepileptic seizures.  Neurology. 2004;  63(3) 516-519
  PubMedGoogle Scholar
• 12 Burneo J G, Martin R, Powell T et al.. Teddy bears: an observational finding in patients with non-epileptic events.  Neurology. 2003;  61(5) 714-715
  PubMedGoogle Scholar
• 13 Forsgren L, Bucht G, Eriksson S, Bergmark L. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study.  Epilepsia. 1996;  37(3) 224-229
  CrossrefPubMedGoogle Scholar
• 14 Hauser W A, Annegers J F, Rocca W A. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota.  Mayo Clin Proc. 1996;  71(6) 576-586
  CrossrefPubMedGoogle Scholar
• 15 Annegers J F, Shirts S B, Hauser W A, Kurland L T. Risk of recurrence after an initial unprovoked seizure.  Epilepsia. 1986;  27(1) 43-50
  CrossrefPubMedGoogle Scholar
• 16 Nelson K B, Ellenberg J H. Predictors of epilepsy in children who have experienced febrile seizures.  N Engl J Med. 1976;  295(19) 1029-1033
  CrossrefPubMedGoogle Scholar
• 17 Chadwick D, Leiderman D B, Sauermann W, Alexander J, Garofalo E. Gabapentin in generalized seizures.  Epilepsy Res. 1996;  25(3) 191-197
  CrossrefPubMedGoogle Scholar
• 18 French J A, Williamson P D, Thadani V M et al.. Characteristics of medial temporal lobe epilepsy: I. Results of history and physical examination.  Ann Neurol. 1993;  34(6) 774-780
  CrossrefPubMedGoogle Scholar
• 19 Zupanc M L. Antiepileptic drugs and hormonal contraceptives in adolescent women with epilepsy.  Neurology. 2006;  66(6, Suppl 3) S37-S45
  CrossrefPubMedGoogle Scholar
• 20 Sabers A, Ohman I, Christensen J, Tomson T. Oral contraceptives reduce lamotrigine plasma levels.  Neurology. 2003;  61(4) 570-571
  CrossrefPubMedGoogle Scholar
• 21 Benbadis S R, Tatum W O. Overinterpretation of EEGs and misdiagnosis of epilepsy.  J Clin Neurophysiol. 2003;  20(1) 42-44
  CrossrefPubMedGoogle Scholar
• 22 Krauss G L, Abdallah A, Lesser R, Thompson R E, Niedermeyer E. Clinical and EEG features of patients with EEG wicket rhythms misdiagnosed with epilepsy.  Neurology. 2005;  64(11) 1879-1883
  CrossrefPubMedGoogle Scholar

Jennifer HoppM.D. 

Assistant Professor of Neurology, University of Maryland School of Medicine

22 S. Greene Street, S12C09, Baltimore, MD 21201

Email: jhopp@som.umaryland.edu