[Info] Conditions Commonly Misdiagnosed as Epilepsy

[PhylisFeinerJohnson]

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 non-epileptic 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 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, check the thread: http://www.coping-with-epilepsy.com...ileptologists-neurosurgeons-pediatric-d-7691/

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

 

[Nakamova]

Can't some of things listed above lead to epilepsy? I though epilepsy was defined by the number of seizures, rather than the initial cause.

 

[Cint]

I agree, Nakamova. Since I have a difficult to control case, many doctors (including epileptologists) have asked me over the years if I have had meningitis, encephalitis, a head injury, or even child abuse, which all have the possibility to lead to epilepsy.

 

[PhylisFeinerJohnson]

Well, therein lies the controversy. Epilepsy was "officially" defined as ANYONE who has had A seizure. Now take some of the misdiagnoses and you do have confusion. But I researched and researched for days and these seemed to be the MOST COMMON misdiagnoses. That's the best I can answer. Any more or other input would be surely appreciated.

 

[RobinN]

Ah .... this is exactly where I have found confusion. I was told and have read it needs to be two seizures, and those two seizures need to be on different days.

However... the insight that Zoe brought up to me was that if you have one of those illnesses that your seizures were confused with... and you cure it... does that mean you had epilepsy, or not. Because we have been led to believe that E can not be cured.

I just posted some information about the immune system. If you improve the immune system and your seizure threshold is raised... does that mean you did not have Epilepsy? Clarity is needed, but I doubt it will be due to the $ trail.

 

[occb]

Thanks for the list Phylis. These are things we can explore with doctors when partner finds someone willing to look into his health issues.

 

[PhylisFeinerJohnson]

Ah .... this is exactly where I have found confusion. I was told and have read it needs to be two seizures, and those two seizures need to be on different days.

However... the insight that Zoe brought up to me was that if you have one of those illnesses that your seizures were confused with... and you cure it... does that mean you had epilepsy, or not. Because we have been led to believe that E can not be cured.

I think if the disease is cured the REASON for the seizures (which aren't necessarily epilepsy) is cured. At least, that's how it sounds to me...

 

[Nakamova]

What if someone has meningitis, and is cured of it, but develops a seizure disorder as a result of the initial infection?

 

[RobinN]

Good point.

What if someone has GI issues and heals, thus eliminating the seizures that were a result of it?
Or if someone is deficient in magnesium or other vitamin or mineral and supplements, thus no longer having seizures are they "cured" of Epilepsy?

Is Epilepsy just the seizure threshold? Since we all have a threshold do we all have the possibility of being labeled with Epilepsy if our threshold is lowered enough to develop seizures?

I tend to use the term seizure disorder. Yet when I look up the common term on wikipedia it gives me this:

Disorder may refer to :
Disease

In human beings, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, and/or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories.

Most of us would argue that E is not a disease, so we are back to square one.

 

[Crystal11]

NAKAMOVA- Its not the number of seizures that give the dianosis of Epilepsy. Usually if you have two seizures you are considered to have Epilepsy or a seizure disorder BUT the EEG or finding of abnormal electrical activity is needed to confirm it.
The seizures are usually the same every time it happens. There are other things neurologists look for as well..

 

[Nakamova]

But often the EEGs come up negative. In that case it is the number of seizures that allow for diagnosis, with or without confirmation from the tests.

 

[PhylisFeinerJohnson]

That's a good question, because by themselves, EEGs are not sensitive enough to distinguish many disorders which cause epileptic seizures. When anticonvulsants don't control seizures or there is a question about the diagnosis of epilepsy, I would think more in-depth testing is required.

 

[RobinN]

One would think so Phylis. My daughter only had one EEG that was abnormal, but that finding was discounted by another neurologist that said it was most likely read wrong.
Her other three were normal.

Yet, the abnormal activity is not occurring 24-7 in all cases. Sometimes it is a hit or miss test, and if they don't catch the unusual brain activity at the precise time it is irregular then ... oh well. It is known to not be accurate 100% of the time, yet they continue to rely on it. In our case, neurologists led my husband to believe that it was a done deal, and my daughters seizures were psychological. My research proved otherwise,but the damage was done, and it was a tough road there for a while. Luckily I had Rebecca's therapist watching the situation and coming to the conclusion that my research and intuition was correct. She suggested that I continue to persevere.

Doctors do not give a patient with seizures the larger picture. I do believe this is $$ vs. time driven. Once we get past that fact, we can begin to ask the right questions and ask for the tests that will give us a clearer picture as to what is occurring.

 

[Cint]

That's a good question, because by themselves, EEGs are not sensitive enough to distinguish many disorders which cause epileptic seizures. When anticonvulsants don't control seizures or there is a question about the diagnosis of epilepsy, I would think more in-depth testing is required.

From Wikepedia:

EEG Limitations

EEG has several limitations. Most important is its poor spatial resolution. EEG is most sensitive to a particular set of post-synaptic potentials: those which are generated in superficial layers of the cortex, on the crests of gyri directly abutting the skull and radial to the skull. Dendrites which are deeper in the cortex, inside sulci, in midline or deep structures (such as the cingulate gyrus or hippocampus), or producing currents which are tangential to the skull, have far less contribution to the EEG signal.
The meninges, cerebrospinal fluid and skull "smear" the EEG signal, obscuring its intracranial source.
It is mathematically impossible to reconstruct a unique intracranial current source for a given EEG signal[citation needed], as some currents produce potentials that cancel each other out. This is referred to as the inverse problem. However, much work has been done to produce remarkably good estimates of, at least, a localized electric dipole that represents the recorded currents.

EEG vs fMRI and PET

EEG has several strong points as a tool for exploring brain activity. EEG's can detect changes within a millisecond timeframe, excellent considering an action potential takes approximately .5-130 milliseconds to propagate across a single neuron, depending on the type of neuron[13]. Other methods of looking at brain activity, such as PET and fMRI have time resolution between seconds and minutes. EEG measures the brain's electrical activity directly, while other methods record changes in blood flow (e.g., SPECT, fMRI) or metabolic activity (e.g., PET), which are indirect markers of brain electrical activity. EEG can be used simultaneously with fMRI so that high-temporal-resolution data can be recorded at the same time as high-spatial-resolution data, however, since the data derived from each occurs over a different time course, the data sets do not necessarily represent the exact same brain activity. There are technical difficulties associated with combining these two modalities, including the need to remove the MRI gradient artifact present during MRI acquisition and the ballistocardiographic artifact (resulting from the pulsatile motion of blood and tissue) from the EEG. Furthermore, currents can be induced in moving EEG electrode wires due to the magnetic field of the MRI.
EEG can be recorded at the same time as MEG so that data from these complementary high-time-resolution techniques can be combined.

As far as to whether E is a disorder or disease, Wikepedia also mentions:

Illness

Illness and sickness are generally used as synonyms for disease. However, this term is occasionally used to refer specifically to the patient's personal experience of his or her disease. In this model, it is possible for a person to be diseased without being ill, (to have an objectively definable, but asymptomatic, medical condition), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalizes a non-disease situation in his or her life). Illness is often not due to infection but a collection of evolved responses, sickness behavior, by the body aids the clearing of infection. Such aspects of illness can include lethargy, depression, anorexia, sleepiness, hyperalgesia, and inability to concentrate.

Disorder

In medicine, a disorder is a functional abnormality or disturbance. Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders.
The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances. In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions. However, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as organic brain syndrome.
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