Epilepsy Talk
Conditions Commonly Misdiagnosed as Epilepsy | February 17, 2010
A moment of unresponsiveness – the inability to recall what just happened…convulsions or jerking movements…sudden stiffness of the body. These are classic symptoms of an epilepsy seizure — triggered by abnormal electrical impulses in the brain.
And while these symptoms may indicate epilepsy, other brain abnormalities or injuries could also lead to seizures.
Having a seizure doesn’t automatically mean you have epilepsy. And without testing, the diagnosis – or misdiagnosis – can be pretty scary. There are loads of conditions that have symptoms similar to epilepsy. Here are the most common…
First Seizures
A first seizure is just what it sounds like — the first seizure a person has. The underlying cause may be determined to be epilepsy, but often the cause can’t be determined.
These isolated seizures are not rare events — up to 5 percent of people in the United States may experience a first seizure that isn’t due to fever or epilepsy. A first seizure typically occurs before age 25, with most taking place in those younger than 15. First seizures seem to strike males a little more often than females, and they may not have a specific or detectable cause. However, a first seizure can affect part of or the entire brain.
Febrile Seizures
These seizures are caused by high fevers, and occur most commonly in infants and young children. Febrile seizures are quite common, affecting 1 in 25 children. The chances of having another febrile seizure are 25% to 30%. While frightening, these seizures don’t cause brain damage or otherwise harm children.
During the seizure, the child may be unconscious, shake, and convulse. Febrile seizures can last longer than 15 minutes or less than a few seconds, but most commonly last one to two minutes.
Febrile seizures typically strike when a child is between 6 months and 5 years old, but they most often occur during the toddler years. These types of seizures may recur during childhood but are usually outgrown.
Nonepileptic Seizure Disorder (NESD)
Nonepileptic events look like seizures, but actually are not. Conditions that may cause nonepileptic events include narcolepsy (a sleep disorder which causes reoccurring need of sleep during the day), Tourette’s syndrome (a neurological condition characterized by vocal and body tics), abnormal heart rhythms (arrhythmias) and other medical conditions with symptoms that resemble seizures.
Because symptoms of these disorders can look very much like epileptic seizures, they are often mistaken for epilepsy. Distinguishing between true epileptic seizures and nonepileptic events can be very difficult and requires a thorough medical assessment, careful monitoring, and knowledgeable health professionals. Improvements in brain scanning and monitoring technology will hopefully improve diagnosis of nonepileptic events in the future.
When someone appears to have seizures, even though their brains show no seizure activity, they are diagnosed as having pseudo seizures which basically means they look like a seizure but aren’t one.
Seizures that are psychological in origin are often called psychogenic seizures. These seizures are most likely triggered by emotional stress or trauma. Some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. It’s a legitimate seizure and should be treated that way, but it is not caused by a problem in the brain.
Then there are physiologic nonepileptic seizures which can be triggered by some sort of change in the brain — typically a change in the supply of blood or oxygen rather than electrical activity.
It’s important to differentiate a seizure from that of a behavioral disorder, but it’s difficult.
Mental Health
Epilepsy can be misdiagnosed as schizophrenia. Some patients suffer hallucinations and other similar symptoms, or even severe psychotic symptoms, making a misdiagnosis of schizophrenia possible. Mood changes and behavioral symptoms also make a misdiagnosis of bipolar disorder possible.
Some of the other possible misdiagnoses include depression, borderline personality disorder, multiple personality disorder, hypochondria, sexuality disorders, and hysteria.
Eclampsia
Eclampsia is a dangerous condition suffered by pregnant women. The symptoms include seizures and a sudden rise in blood pressure. A pregnant woman who has an unexpected seizure should be taken to the hospital immediately. Eclampsia occurs in about 1 out of every 2,000 to 3,000 expectant women. The seizures cause convulsions or changes in personality such as agitation. After the eclampsia is treated and after the woman has the baby, she usually won’t have any more seizures or develop epilepsy.
Meningitis
Meningitis is an infection that causes swelling of the membranes of the brain and spinal cord, most often caused by a virus or bacteria. Viral infections usually clear up without treatment, but bacterial infections are extremely dangerous and can lead to brain damage and even death. Symptoms of meningitis include fever and chills, severe headache, vomiting, and stiff neck.
Encephalitis
Encephalitis is an inflammation of the brain and is usually caused by a viral infection. Symptoms include fever, headache, vomiting, confusion, and stiff neck.
Migraine
Migraine is a type of headache thought to be caused, in part, by a narrowing of blood vessels in the head and neck, which reduces the flow of blood to the brain. People who have migraines may also have auras and other symptoms, including dizziness, nausea, and vomiting. Certain conditions may bring about a migraine, including allergies, menstrual periods, and muscle tension. Some foods, including red wine, chocolate, nuts, caffeine, and peanut butter, can also cause a migraine.
Sleep Disorders
According to the Cleveland Clinic, about 75% of the adult population in the United States suffers from some type of sleep disorder. These include sleep apnea…insomnia…restless legs syndrome…narcolepsy… sleepwalking…talking in one’s sleep…sleep paralysis…mild and chronic muscle spasms that occur during sleep…and night terrors, to name just a few.
Brain Injury
Although the symptoms of severe brain injury are hard to miss, it is less clear for milder injuries, or even those causing a mild concussion. The condition goes by the name of “mild traumatic brain injury” (MTBI). Symptoms can be mild, and can continue for days or weeks after the injury.
Post-concussive brain injury is also often misdiagnosed. A study found that soldiers who had suffered a concussive injury in battle often were misdiagnosed on their return. A variety of symptoms can occur in post-concussion syndrome and these were not being correctly attributed to their concussion injury.
In addition, a brain tumor or an infection in the brain, can be mistaken for epilepsy.
Cardiac Disorders
EEGs alone may not clearly distinguish epilepsy from cardiac disorders. Numerous studies point to a connection between SUDEP, Unexplained Death in Epilepsy and cardiac problems. More extensive evaluation by a cardiologist can help identify cardiac disorders which may be an underlying cause of an individual’s seizures.
TIAs
Transient Ischemia Attacks are caused by a sudden diminished blood flow in some areas of the brain that may be stroke related. Seizure-like symptoms may include changes in consciousness, speech or vision problems.
Failed Drug Therapy
If trials of different anti-seizure medications fail, it could be because the cause of the seizures is not epilepsy.
EEGs
EEGs alone are not sufficient to make a definite diagnosis of epilepsy. It is not a sensitive enough diagnostic tool to distinguish many disorders which cause epileptic seizures. When anticonvulsants don’t control seizures or there is a question about the diagnosis of epilepsy, the neurologist, patient, or care giver must seek further evaluation to find the underlying cause of the seizures.
Simple Mistakes
And then, of course, there is the element of human error. Changes in metabolism – such as low blood sugar — from health conditions like kidney and liver problems can present as a seizure. Drug use or withdrawal from alcohol can be construed as epilepsy. A congenital health problem, like down’s syndrome, stroke or alzheimer’s disease may be misdiagnosed.
The bottom line? Make sure you have a good neurologist or epileptologist…get thorough testing…keep a seizure diary…and be pro-active.
For a nationwide list of GOOD neurologists…epileptologists…neurosurgeons…and pediatric doctors, click the sidebar on the right where it says “Top Posts.”
Resources:
http://www.everydayhealth.com/epilepsy/understanding/when-are-seizures-not-epilepsy.aspx
http://www.webmd.com/epilepsy/conditions-similar-to-epilepsy
http://epilepsy.suite101.com/article.cfm/epilepsymisdiagnosis_is_common
http://www.wrongdiagnosis.com/e/epilepsy/misdiag.htm#misdiagnote
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Hi Phylis,
Thank you for doing your research. I did not know all of these reasons for seizures.
I noticed on febrile seizures that one can last 15 minutes or less than a few seconds. If a febrible seizure last 15 minutes, wouldn’t that cause brain damage?
Ruth
Comment by Ruth Brown — February 17, 2010 @ 5:54 am
Here’s what the Mayo Clinic says at http://www.mayoclinic.com/health/febrile-seizure/DS00346/DSECTION=complications
“Although febrile seizures may cause great fear and concern for parents, most febrile seizures produce no lasting effects. Simple febrile seizures don’t cause brain damage, mental retardation or learning disabilities, and they don’t mean your child has a more serious underlying disorder.
Febrile seizures also aren’t an indication of epilepsy, a tendency to have recurrent seizures caused by abnormal electrical signals in the brain. The odds that your child will develop epilepsy after a febrile seizure are small. Only a small percentage of children who have a febrile seizure go on to develop epilepsy, but not because of the febrile seizures.
Recurrent febrile seizures
The most common complication of febrile seizures is the possibility of more febrile seizures. About a third of children who have a febrile seizure will have another one with a subsequent fever.”
Comment by Phylis Feiner Johnson — February 17, 2010 @ 9:42 pm
Looking over different conditions still unclear of what my 13yr old daughter has. Seizures started last fall,1 per mo. Then EEG,slight abnormalities. MRI-showed nothing substantial.
Placed on Kepra, seizures became more violent. increase in Kepra, more seizures..Changed to Trileptal-2wks no seizure then 1 per week. increase Trileptal. seizures 2x per wk added zonisamide.Seizures continued @ 2x but much worse. Taken off all meds & hospitalized for video eeg 6days. then 2days w/portable unit bk to school.no seizures for 3wks 2days on no meds.Just had one May 3rd. Full body. Dr.s suggest child psyc? Seizures seem to happen only @ skl & a few @ youth grp. I am very puzzeled trying to figure out my next step. I would appreciate any suggestions.
Thank you, Chris
Comment by Chris Gonzales — May 5, 2010 @ 10:19 am
First of all Chris, let’s remember that she’s a teenager and her hormones are probably out of whack.
For many women, certain hormones seem to trigger seizures at particular times in their menstrual cycle. It can be during ovulation or menstruation and it’s known as “catamenial epilepsy.” So that MAY be a contributing factor
Although psychological(psychogenic)seizures are most likely triggered by emotional stress or trauma, some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. It’s a legitimate seizure and should be treated that way, but it is not caused by a problem in the brain.
If it were me, I’d start a daily diary, noting activities, behaviors, sleeping and eating patterns, as well as when the seizures happen, how long they last and what happens afterwards. Then I’d take it back to the neuro and see if he/she can get a clue of what’s going on.
Talk therapy certainly has helped me. Plus my shrink is a psychiatrist, so he can change my meds based upon depression. (Research shows that 80% of patients with epilepsy also have some kind of a depressive disorder. Upwards of 60% have a history of significant episodes of depression. And 10-32% experience symptoms of anxiety.)
As for meds: I’m on Lamictal which at its lowest level is for anti-anxiety, the next level acts as an anti-seizure med and the top level is for bi-polar people. (I take it in the AM because it got me too hyper at night, but it’s different for each person.) That’s supplemented at night with Klonopin which is an anti-seizure, anti-anxiety drug.
So talk therapy and that magic mix of meds are what works for me at this point. And I’ve had epilepsy for 40 years!
Good luck. Let us know how things progress…
Comment by Phylis Feiner Johnson — May 5, 2010 @ 7:59 pm
Hi Chris, I am sorry that you are on the medicine merry-go-round. That is miserable trying to find out what medicines work and which ones do not. Any time their is an increase of seizures with a medicine, report it to her doctor.
The EEG did show up seizure activity, so she does have epilepsy.
Since the V-EEG did not show up anything, that means that she has the same thing I do. I have both epilepsy and NEST (non epileptic seizure disorder), psychcogenic.
I do not have therapy but most people do. It is more common than you think. Most people do not want it out in the open. That is why most people do not know about it. Be open and educate other people.
I am on Lamictal, Neurontin, Mysoline, Keppra and clonazepam. They work for me. Everyone is different. I have had epilepsy for 61 years, now.
Let us know if we can help you, in any way.
Comment by Ruth Brown — May 5, 2010 @ 10:31 pm
Dear Troubled,
Here are some links which will help you better understand psychogenic seizures:
http://my.epilepsy.com/node/4232
http://my.epilepsy.com/node/78
http://hsc.usf.edu/com/epilepsy/pnesbrochure.pdf
http://www.wrongdiagnosis.com/p/psychogenic_nonepileptic_seizures/intro.htm
Hope this helps!
Comment by Phylis Feiner Johnson — May 13, 2010 @ 6:04 am
Hi Troubled,
I have both epilepsy and NEST (non-epileptic-seizure-disorder.) I also have diabetes which has seizures as well:
http://www.isletsofhope.com/diabetes/complications/seizures_1.html
Do not be troubled about it. I have had seizures for 61 years now. I have learned to have a positive attitude toward it. I take it as it comes.
My friends accept me as I am. Since I was 6 years old, I told everyone that I had epilepsy. I still do. My neighbors accept me as I am and so do my friends.
Phylis has a subject on triggers in her website here. You might want to see what they are to help stop seizures.
Remember, Laughter is the best medicine.
Comment by Ruth Brown — May 15, 2010 @ 5:14 am
I was insulted today. I was told that someone was faking their NEAD seizures. I have been accused of the same thing at the ER room. They have even taken the fact that I have epilepsy off of my hospital charts.
I have both epilepsy and NEAD. They are real, not fake. I am going to have a V-EEG to prove that I have both.
Comment by Ruth Brown — July 21, 2010 @ 5:06 am
Ruth, as you know, some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. That doesn’t mean they’re not real.
And if they just did an EEG to evaluate you, it’s pretty useless because the EEG is mostly superficial and doesn’t go very deep into the brain.
An EEG can help identify the location, severity, and type of seizure disorder. But an abnormal EEG does not diagnose epilepsy nor does a normal EEG reading exclude it.
I think a V-EEG is a good idea. It’s much more precise because seeing EEG and video data at the same time permits precise correlation between seizure activity in the brain and the patient’s behavior during seizures.
Video-EEG can also be vital in the diagnosis of epilepsy and epileptic seizures because it allows the doctor to determine:
Whether events with unusual features are epileptic seizures…
The type of epileptic seizure, and…
The region of the brain from which the seizures arise.
Comment by Phylis Feiner Johnson — July 21, 2010 @ 7:43 pm
I do have both epilepsy and NEAD. It was an EEG that the doctor went by. At that time, I did not have a seizure so nothing showed up. So, it showed that I was not having seizures at the time of the EEG.
I should have had an EEG done before the colonoscopy while I was having seizures.
I am going to tell my GP and neurologist that they have taken off the fact that I have epilepsy. Both of them know that I have epilepsy. I will ask for a V-EEG.
Comment by Ruth Brown — July 22, 2010 @ 9:52 am
I agree. A V-EEG would be much more accurate…
Comment by Phylis Feiner Johnson — July 22, 2010 @ 7:18 pm
I see my neurologist in August. I will ask for one then.
Comment by Ruth Brown — July 24, 2010 @ 9:46 am