Several conditions can result in abnormal movements, sensations, or loss of awareness, but may not be associated with an abnormal electrical discharge in the brain. These conditions are imitators of epilepsy.
Fainting spells (syncope)
May incorrectly be considered seizures. Syncope can provoke a seizure, called convulsive syncope. This is distinguishable from epilepsy by recognition of a typical clinical picture and setting for fainting.
Interruption of brain circulation
Produces symptoms that can be similar to those of epilepsy.
Low blood sugar (hypoglycemia) or low oxygen (hypoxia)
Can cause confusional episodes that look like seizures.
Some patients have confusional spells with migraine headaches. Confusional migraine can be mistaken for a seizure.
With inappropriate falling asleep due to narcolepsy, sleep apnea, nigh terrors or poor quality sleep at night can look like seizures. Sleep disorders are characterized by the ability to awaken patients during the episodes, and by a prodrome of irresistible sleepiness.
Patients sometimes have movement disorders with tremors, nervous tics, dystonic posturing, or other forms of abnormal movement such as that seen in Huntington's chorea. These episodes may be thought to be simple partial motor seizures.
The most difficult imitators of epilepsy are the psychological imitators. Panic attacks, hyperventilation spells, and psychologically-based seizures can provide real diagnostic difficulties. Breath-holding spells are variants of temper tantrums in children. The child becomes angry, holds his or her breath, turns blue, loses consciousness and exhibits some jerking. Night terrors are screaming episodes during sleep in children. These last two conditions are alarming, but benign.
Stanford has special expertise in diagnosing and treating patients with the condition called non-epileptic seizures (NES), also sometimes known as pseudoseizures, or psychogenic seizures. In this condition, subconscious stress causes the patient to have seizure-like episodes.
A non-epileptic seizure does not reflect conscious "faking" of a seizure, but a subconscious psychosomatic stress reaction. Some patients with non-epileptic seizures have a background, even years before, of physical, emotional, verbal, or sexual abuse. Others are under certain hard-to-recognize causes of stress. Video-EEG monitoring usually is needed to secure a diagnosis of psychogenic seizures, since the expected EEG changes during a seizure will be absent. The treatment for these is psychological counseling, behavior modification therapy, and sometimes antidepressant or anti-anxiety medications.
Using a multidisciplinary approach under the direction of John Barry, MD, and staff of the Department of Psychiatry, neurological evaluation and testing may be supplemented by neuropsychological and neuropsychiatric testing. Dr. Barry has initiated a group therapy program for non-epileptic seizure patients, individually tailored to the needs of the NES patient. The Stanford Comprehensive Epilepsy Program stands out among epilepsy programs for its interest in performing research on diagnosis and management of non-epileptic seizures.
Imitators of epilepsy can be very difficult to distinguish from seizures. Some patients have been on antiepileptic medications inappropriately for decades for conditions that are not and never were seizures. Director of the Stanford Comprehensive Epilepsy Program, Robert Fisher, MD, PhD, has published a book entitled Imitators of Epilepsy, reviewing these conditions.
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