E. First Seizures - Seizure Vs non seizure
There are other paroxysmal events which can mimic a seizure. A sequenced account of the event, precipitating factors, reproductivity, the gain expected out of the event help us to make the decision. The commonest paroxysmal events confused with seizures are, breath holding spells in infants, syncope, cardiac arrhythmias, pseudoseizures, and migraine variants beyond infancy. The timing of the events, injury, specific distribution and pattern of abnormal movements, post event deficits and loss of consciousness, point towards a true seizure EEG may help but is not diagnostic. Observation of the event, abnormal EEG, abnormalities on anatomic and functional neuro imaging and post ictal elevation of serum prolactin may favour a true seizure.
F. Provoked Vs unprovoked seizures
Seizures may be a manifestation during an acute inter current illness. These are called provoked seizures or symptomatic seizures. Metabolic events including, hypoglycemia, hypocalcemia, hypomagnesemia solitary episodes in acute meningoencephalitis, dyselectrolytemia, drug intoxication, hypoxia and trauma are not epilepsy. Similarly febrile seizures are not epilepsy.
G. Investigations: For the first seizure, always rule out metabolic causes and define that it is unprovoked. EEg is indicated in all unprovoked seizures.
Neuro Imaging - Where affordable CT scan is indicated in recent onset of seizures (any type) and literature clearly indicates the need to investigate partial seizures with CT or MRI. MRI is better than CT for structural migration defects, temporal lobe lesions and other anatomic causes.
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