Conditions Commonly Misdiagnosed as Epilepsy
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…
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.
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.
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 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 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 is an inflammation of the brain and is usually caused by a viral infection. Symptoms include fever, headache, vomiting, confusion, and stiff neck.
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.
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.
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.
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.
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, not epilepsy.
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.
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.