The evaluation of children and adults with new-onset seizures, emphasizing differential diagnosis, classification, evaluation, and management.
Approximately 8% to 10%.
A careful history to exclude nonepileptic paroxysmal events.
Cardiovascular syncope and psychogenic nonepileptic events.
Epilepsy is defined as (1) at least two unprovoked seizures occurring more than 24 hours apart, (2) one unprovoked seizure with a probability of further seizures of at least 60% over the next 10 years, or (3) diagnosis of an epilepsy syndrome.
Brief jerking of one or more limbs, lasting <5 seconds each, without altered awareness.
Artifact at P4.
A careful history taken from both the patient and witnesses.
Rhythmic hip flexion and adduction with leg-crossing, often accompanied by a distant expression.
Headache and sensory symptoms associated with collapse, exacerbated by straining.
Recurrent spells of lightheadedness without vertigo.
No, it cannot be made solely by relying on EEG findings.
It typically brings the patient to medical attention, even if prior seizures were unrecognized.
They are usually visible on MRI but may require specific epilepsy protocols.
Excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis.
They begin within one region or hemisphere and can be classified based on awareness and motor symptoms.
Unresponsive periods without motor phenomena or motor phenomena with bizarre jerking, often prolonged and with minimal postictal phase.
Correctly identifying the epilepsy type and syndrome, as well as the underlying etiology.
Diffuse delta slowing.
A generalized tonic-clonic seizure.
Prolonged standing, dehydration, change in posture, warm environment, or emotional upset.
What has caused this?
A structural brain change that results in epilepsy, such as developmental abnormalities or acquired brain processes.
Approximately one-quarter.
Often provoked by excitement or frustration.
Approximately 24%.
Sudden voluntary movement, leading to brief attacks of abnormal movement, often dystonic.
A careful history taken from both the patient and witnesses is critical.
Usually minutes.
Vital signs, clinical findings, and a history of medication use or withdrawal.
Whether the patient has experienced prior seizures, including non-convulsive types.
Sinus bradycardia.
Mannerisms that may be simple (like body-rocking) or complex (like finger movements) and can be interrupted by tactile or verbal stimulation.
Sudden loss of consciousness with pallor, atonia, or tonic posturing, often triggered by fright, exercise, or surprise.
Myoclonus of one or more limbs or face, occurring in brief clusters lasting <3-5 seconds with pauses of variable duration.
Brief episodes with a feeling of impending doom, shortness of breath, palpitations, and awareness of the situation.
It is used if information is inadequate to determine the epilepsy type.
A transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Cognitive, psychiatric, or medical comorbidities.
19.3% for nonspecialists versus 5.6% for neurologists.
Remission often occurs by adolescence.
Histamine antagonists like diphenhydramine and doxylamine.
Absent.
Sudden onset of focal neurologic symptoms that resolve completely within 24 hours, typically within 30-60 minutes.
Lightheadedness, blurred vision, ringing in the ears, pallor, diaphoresis, and abdominal discomfort.
Repetitive stereotyped flexion of toes, ankles, knees, and hips that resolve with waking.
A system that evaluates seizure type(s), epilepsy type, epilepsy syndrome, etiology, and comorbidities.
Frequent seizures and epileptiform discharges (epileptic).
A disorder of the brain characterized by an enduring predisposition to generate epileptic seizures.
One or more types of focal-onset seizures, which may include focal to bilateral tonic-clonic seizures.
Juvenile myoclonic epilepsy.
Lack of brain perfusion.
14 and 6 positive spikes, which are a normal variant and not epileptiform.
Juvenile myoclonic epilepsy.
Episodic lightheadedness, chest pain, blurred vision, and abdominal pain that come on with standing and resolve with sitting/lying down.
Focal, generalized, and unknown onset.
It informs the choice of investigations, treatment, and prognosis.
Early in life.
Back-arching, dystonic posturing of the limbs, and turning/tilting of the head, often provoked by feeding.
They have convened a task force to provide definitions for various syndromes.
Identifiable causes such as toxins, drugs, or metabolic factors.
Often daily or more.
Focal epilepsy.
Seizures present with positive symptoms due to excess neuronal discharge, while transient ischemic attacks involve loss or reduction of neuronal function.
It helps choose cost-effective investigations and therapies and provides an accurate prognosis.
EEG can confirm a diagnosis of epilepsy as opposed to a single unprovoked seizure, influencing treatment recommendations.
Terminology, such as the difference between lightheadedness and vertigo, or nausea and an abnormal rising sensation.
Abnormal motor activity in the later third of sleep where individuals act out their dreams and can recall the events.
A patient has one or more types of generalized seizures, including tonic, tonic-clonic, absence, myoclonic, or atonic seizures.
Autosomal dominant condition characterized by brief episodes of cerebellar ataxia triggered by sudden movement, emotion, or illness.
Typically less than daily to monthly.
Contralateral head or eye deviation, contralateral dystonic posturing with ipsilateral automatisms.
It reverts to diffuse slowing after overall suppression.
Lost bladder continence and bit the side of her tongue.
From the neonatal period through late childhood.
Paroxysmal events of recurrent vomiting that may last hours, interspersed with symptom-free periods.
Spontaneous occurrence and photic stimulation.
Tantrums are brief behavioral dyscontrol in young children, while rage attacks are prolonged, aggressive reactions in older children and teens.
Visual aura, typically a scintillating scotoma followed by a migraine headache.
Identifiable in approximately one-quarter of epilepsy cases.
High risk of lifelong, drug-resistant seizures and variable degrees of intellectual disability.
Nonepileptic staring spells, psychogenic nonepileptic events, syncope, parasomnias, and breath-holding spells.
Usually present with confusion and possible language dysfunction if it affects the dominant temporal lobe.
An acute brain process such as encephalitis, stroke, or traumatic brain injury.
May have associated myoclonic or generalized tonic-clonic seizures.
Standing up too quickly and specific situations like blood draws.
Her paternal aunt had epilepsy as a young adult, which was well controlled with medication.
Structural, genetic, infectious, metabolic, immune, and unknown.
Affects one or more limbs, often switching sides from event to event, increased when stimulated, and suppressed when gently restrained.
It provides key information for optimal investigations, treatment, and accurate prognosis.
A characteristic cluster of clinical and EEG features that may be supported by specific etiologic findings.
Incomplete history taking and overinterpretation of the EEG.
Epilepsies that are associated with underlying encephalopathy.
Anxiety, delusions, delirium, diaphoresis, hypertension, tachycardia, hyperthermia, hyperreflexia, mydriasis, piloerection.
Increased CNS excitation and seizures.
Asystole.
The EEG was consistent with syncope due to a cardiac cause, not a seizure.
They include self-limited neonatal epilepsy, self-limited infantile epilepsy, self-limited epilepsy with autonomic seizures, and self-limited epilepsy with centrotemporal spikes.
Episodes of hand-twitching in the morning.
Staring off, more likely during quiet activities, and can be interrupted with tactile stimulation.
A careful clinical history taken from both the patient and witnesses of the clinical events.
Involuntary, sudden, rapid, repetitive movements or vocalizations that can be interrupted and often abate during sleep.
Aura of focal weakness with or without speech disturbance, often with a positive family history.
They carry important implications for the choice of specific therapy and prognosis.
Approximately 15% to 20%.
Cocaine, amphetamines, phenethylamines, bath salts.
Normal, focal slowing, or focal discharges.
Oxcarbazepine.
Generalized polyspike-and-wave discharge and several myoclonic jerks.
Abrupt onset of anxiety and feeling off balance, often with associated nystagmus.
Behaviors like night terrors and sleepwalking that arise from deep non-REM sleep, typically lasting >3-5 minutes.
They engage bilateral brain networks from onset.
Triggered by pain, crying, or fright, often resulting in a color change (cyanotic or pallid).
Infantile epileptic spasms syndrome, Dravet syndrome, Lennox-Gastaut syndrome.
Rapid eye movements, head-tilt, and nodding, but with retained awareness.
It helps avoid overinterpretation of EEG and clarifies the diagnosis before starting antiseizure medication.
Generalized convulsive events.
Focal deficits and abnormal vital signs, including fever.
Seizure type and epilepsy type.
Skin color change, motor findings, response to voice or touch, and postictal symptoms.
Infants are hypertonic but not spastic, with excessive startle responses.
Tremor, tachycardia, hypertension, diaphoresis, nausea, anxiety, irritability, insomnia, hallucinations.
Absence, myoclonic, or focal seizures without motor manifestations.
Many people presenting with a 'first seizure' may have a history of prior seizures that were not recognized.
A history of confusion or behavior change.
Usually less than 10-30 seconds.
Defecation, urination, miosis, bradycardia, bronchospasm, emesis, lacrimation, and salivation.
Usually see generalized spike-and-wave discharge on routine EEG.
