1. Differential Diagnosis

2. Salient Features • Often observed to be absent minded • Brief episodes of blank staring and inattention • Eye blinking • Reflex scratching of head • Lip smacking and chewing movements • Occurs many times a day then resumes usual activity • 10 year old girl • Poor academic performance

3. Differential Diagnosis Nonepileptic syndromes: Syncope Psychogenic seizures Sleep disorders Migraine Seizures: Complex Partial Seizures Absence seizures

4. Differential Diagnosis Syncope • More likely if the event was provoked by acute pain or anxiety or occurred immediately after arising from the lying or sitting position • Features suggesting syncope include • preceding light-headedness • sweating • pallor

5. Differential Diagnosis Psychogenic seizures • It is precipitated by underlying psychological distress. Patients with a previous psychiatric history are likely to be at higher risk • In general, compared to epileptic seizures, psychogenic seizures display a longer duration, a more waxing and waning nature, and nonphysiologic progression • The diagnosis of psychogenic seizures does not exclude a concurrent diagnosis of epilepsy since the two often coexist

6. Differential Diagnosis Sleep disorders • Sleep disorders may result in microsleeps or more prolonged sleep attacks due to any cause of hypersomnolence. • The most common cause is disrupted sleep from obstructive sleep apnea, a condition which is common among patients with hypertension, atherosclerosis, and obesity.

7. Differential Diagnosis Migraine • Migraine auras are distinguished from seizures by their more gradual, often visual, warning and longer duration. • Associated symptoms include nausea or vomiting, photophobia, and phonophobia. • Loss of consciousness is rare.

8. Differential Diagnosis Nonepileptic syndromes: Syncope Psychogenic seizures Sleep disorders Migraine Seizures: Complex Partial Seizures Absence seizures

9. Classifications of Seizures Harrison’s Principles of Internal Medicine, 17th ed.

10. Differential Diagnosis Partial (or focal) seizures • Originate in a localized area of cortex • Simple-partial seizures do not affect consciousness and may have motor, sensory, autonomic, or psychiatric symptoms. • Complex-partial seizures include alteration in consciousness coupled with automatisms (e.g., lip smacking, chewing, aimless walking, or other complex motor activities).

11. Differential Diagnosis Generalized seizures • Involve diffuse regions of the brain in a bilateral symmetric fashion • May occur as a primary disorder or may result from secondary generalization of a partial seizure • Tonic-clonic seizures (grand mal) • Sudden loss of consciousness • Loss of postural control • Tonic muscular contraction producing teeth-clenching and rigidity in extension (tonic phase), followed by rhythmic muscular jerking (clonic phase)

12. Differential Diagnosis Absence seizures • Sudden, brief lapses of consciousness without loss of postural control • Produce automatisms, such as repetitive lip smacking, or mild clonic or myoclonic movements, including mild jerking of the eyelids • Usually begins in childhood ages(4-8) or early adolescence • Seizures can occur hundreds of times per day • Resemble moments of daydreaming or absent-mindedness

13. Differential Diagnosis Atypical Absence • Lapse of consciousness longer in duration and less abrupt in onset and cessation. • More obvious motor signs are present • Associated with diffused or multifocal abnormalities of the brain • May accompany other signs of neurologic dysfunction such as mental retardation.

14. Differential Diagnosis Complex Partial Seizures • Transient impairment of ability to maintain normal contact with environment • Impaired recollection of ictal phase • Automatisms show behaviors such as chewing, lip smacking, swallowing • Transition to full recovery may range from seconds to an hour

15. Differential Diagnosis