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Harrison's Principles of Internal Medicine, 18e
| Part 17. Neurologic Disorders > Section 2. Diseases of the Central Nervous System > |
Differential Diagnosis of Seizures
Sections: Syncope, Psychogenic Seizures, Treatment: Seizures and Epilepsy, Treatment of Underlying Conditions, Avoidance of Precipitating Factors, Antiepileptic Drug Therapy, When to Initiate Antiepileptic Drug Therapy, Selection of Antiepileptic Drugs, Antiepileptic Drug Selection for Focal Seizures, Antiepileptic Drug Selection for Generalized Seizures, Initiation and Monitoring of Therapy, When to Discontinue Therapy, Treatment of Refractory Epilepsy, Surgical Treatment of Refractory Epilepsy, Status Epilepticus.
Topics Discussed: anterior temporal lobectomy; anticonvulsants; callosotomy; carbamazepine; clonazepam; epilepsy; ethosuximide; felbamate; focal cortical resection; gabapentin; generalized seizures; grand mal epilepsy; hemispherectomy for epilepsy; lamotrigine; levetiracetam; monitoring drug therapy outcomes; oxcarbazepine; pharmacotherapy of neurologic disorders; phenobarbital; phenytoin; primidone; seizure, psychogenic; seizures; seizures, focal; status epilepticus; status; epilepticus, tonic-clonic; syncope; tiagabine; tonic - clonic seizures; topiramate; valproic acid; zonisamide.
Excerpt:"Disorders that may mimic seizures are listed in Table 369-6. In most cases seizures can be distinguished from other conditions by meticulous attention to the history and relevant laboratory studies. On occasion, additional studies such as video-EEG monitoring, sleep studies, tilt-table analysis, or cardiac electrophysiology, may be required to reach a correct diagnosis. Two of the more common nonepileptic syndromes in the differential diagnosis are detailed below.(See also Chap. 20) The diagnostic dilemma encountered most frequently is the distinction between a generalized seizure and syncope. Observations by the patient and bystanders that can help differentiate between the two are listed in Table 369-7. Characteristics of a seizure include the presence of an aura, cyanosis, unconsciousness, motor manifestations lasting >15 seconds, postictal disorientation, muscle soreness, and sleepiness. In contrast, a syncopal episode is more likely if the event was provoked by acute pain or anxiety or occurred immediately after arising from the lying or sitting position. Patients with syncope often describe a stereotyped transition from consciousness to unconsciousness that includes tiredness, sweating, nausea, and tunneling of vision, and they experience a relatively..."
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