![]() Munchausen syndrome and Munchausen syndrome by proxy also may present as seizures. A child with autism may have stereotyped movements that convince a concerned parent that the child is having seizures. Benign events, such as hypnic jerks, may prove very frightening to the parents of a child who recently suffered a febrile seizure. Parents of children who have health challenges that may include previous seizures may be very sensitive to any perceived abnormality in the child's health. Table 1 provides a brief overview of nonepileptic events that mimic specific seizure types that occur particularly in children. Benign or at least nonepileptic behaviors may be mistakenly identified as seizures or described in rather dramatic terms. Cerebral imaging studies may demonstrate a structural brain abnormality.Ĭertain circumstances can erroneously heighten suspicion of seizures by the patient, parent, and physician. For example, mental retardation, cerebral palsy, or the presence of neurocutaneous lesions is noteworthy. They also help classify epilepsy as either symptomatic or idiopathic. ![]() Physical examination findings that indicate an abnormality of brain function provide further evidence of an increased likelihood of seizures. ![]() 11,12 A family history is important, because epilepsy in first-degree relatives is another risk factor. It is generally understood that relatively remote trauma of a minor degree confers very little risk, but prolonged loss of consciousness or a penetrating head injury are significant risk factors for seizure episodes. 9,10 An additional helpful clue from the history is a past brain injury from trauma or infection. For example,a history of febrile seizures (particularly if prolonged) is a well-recognized risk factor for the development of temporal lobe epilepsy caused by mesial temporal sclerosis. Most often, seizure history related by the patient's parents and the physical findings will lead the physician to suspect epilepsy. The rationale for treating children with recurrent seizures is that treatment will ameliorate seizure recurrence. Therefore, little advantage is gained by treating first-time seizures, whether they are provoked by an identified acute insult or they occur out of the blue. 8 Seizure frequency and whether the seizures are generalized or partial have stronger predictive power. ![]() 7 Furthermore, the number of seizures that occur before treatment is initiated is not necessarily associated with a greater likelihood of medical intractability. Prolonged seizures can cause brain injury, but epidemiological studies have not provided evidence that prolonged first seizures in otherwise healthy persons increase the risk of subsequent seizures. Treatment with antiepileptic medication reduces the risk of a recurrence after a first seizure, but there is little evidence that treatment prevents the later development of epilepsy. 5 Increased risk of recurrence is associated with factors such as a remote, symptomatic cause (eg, brain injury) abnormal EEG and seizure during sleep. The risk of recurrence within 2 years after a first-time, unprovoked seizure is approximately 35% to 40%. 3 When epilepsy is attributed to a brain abnormality (eg, mental retardation, cerebral palsy, malformation), it is classified as "symptomatic." Epilepsy is considered "idiopathic" when there is no recognized brain abnormality. 1,2 The incidence of epilepsy is highest in early childhood and peaks again late in life. Most seizures arise in the cerebral cortex, although subcortical structures can also generate seizures. A careful, detailed history and physical examination supplemented by an electroencephalogram (EEG) will, in most cases, result in a correct diagnosis.Įpileptic seizures are paroxysmal, abnormal behaviors caused by excessive, hypersynchronous firing of neurons in the brain. Inattentive staring may be attributed to attention deficit disorder but may, in fact, be due to either absence or complex partial seizures.Īn orderly approach to the differential diagnosis of paroxysmal events is the best way to avoid misdiagnosis. It is also the case that epileptic seizures can be subtle and difficult to recognize. When epilepsy is incorrectly diagnosed in these patients, unnecessary seizure medication is likely to be prescribed, and correct diagnosis and treatment is delayed. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures. Children with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |