Disorders To Be Distinguished From Epilepsy

Before treatment with anticonvulsants begun, diagnosis of epilepsy must be as certain as possible. When treatment with anticonvulsants has started, and no improvement occurs at all, then the diagnosis of epilepsy should be considered.

The conditions that people often mistaken epileptic seizures for are; fainting attack and psychogenic (pseudo epileptic)
 A detailed medical history and clear witnessed account of the attacks are a must for differentiating these conditions.
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SYNCOPE (FAINTING)
 Syncope is much more common than epilepsy, and the main differences from epileptic seizures are shown in table 17.There is loss of consciousness due to a sudden decrease in the cerebral blood flow. Syncope may be divided further in three groups:

Reflex syncope (vasovagal syncope)

This is the most common type and includes simple fainting. Precipitating factors are anxiety, hunger,
or any unpleasant experience causing vagal nerve stimulation and reduced venous return. Standing at parades in warm weather (when venous pooling occurs in legs) is a common cause of fainting.

The onset is often gradual, with a feeling of faintness, nausea or dizziness. Blurring r blacking out of vision is often present before the patient slumps to the floor.
Loss of consciousness is short, and often there are some uncoordinated clonic jerks (
Causing the confusion with epileptic seizures).there is pallor and sweating and the pulse is slow.

Recovery is quick without confusion. Treatment is to increase the blood flow to the head by putting the head between the knees, or to lie down.

Cardiac syncope
This is caused by heart disease, disturbance of the heart’s rhythm or reduces cardiac output. The attacks can occur in any situation; in children it is often seen after exertion.
A prolonged ECG maybe necessary to make the correct diagnosi

Postural syncope
This occurs within seconds or minutes of assuming an upright position in patients, whose postral reflexes are impaired.
(Elderly people, diabetic patients or due to medication or alcohol)

Breath holding spells
These occur in infants and children between who cannot restrain their emotions. There is a sudden arrest
Of the respiration followed by cyanosis, unconsiousness and sometimes twitching lasting a few seconds.
The attack stops spontaneously and never results in brain damage.

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