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A. Seizure Differential

  1. Syncope, Presyncope
  2. Transient ischemic attack
  3. Transient global amnesia
  4. Cardiac Arrhythmia
  5. Migraine (atypical)
  6. Vertigo
  7. Tremor
  8. Breath-Holding / Functional

B. Seizure Syndromes

  1. Epilepsy secondary to CNS anatomic abnormalities
    1. Aneurysms (with and without rupture)
    2. Congenital malformations
    3. Tumors
    4. Inflammatory: infection on idiopathic inflammation
  2. Lennox-Gastaut Syndrome: tonic, atonic, myoclonic seizure
  3. Benign infantile partial epilepsy: motor arrest, staring
  4. Benign partial epilepsy with centrotemporal spikes
  5. Benign epilepsy of childhood with occipital paroxysms
  6. Benign partial epilepsy with extreme somatosenosry potentials
  7. Landau Kleffner and other cognitive deficiency syndromes
  8. Benign partial epilepsy of adolescence
  9. Myoclonic Epilepsy
    1. Severe myoclonic epilepsy in infancy
    2. Juvenile myoclonic Epilepsy
    3. Typical myoclonic epilepsy
  10. Myoclonic astatic epilepsy: myoclonic, astatic, absences, tonic (during sleep)
  11. Childhood and Typical Absence Seizure
  12. Epilepsy with myoclonic absences (may involve eyelid, perioral areas)

C. Causes of Seizures in Adults [2]

  1. Idiopathic
  2. Post-Traumatic
  3. Post- or peri-stroke
  4. Tumor - ~10% of new onset seizures
  5. Recreational Drugs
    1. Alcohol - withdrawal seizures more common than during use
    2. Cocaine
    3. MDMA ("ecstasy")
  6. Eclampsia
  7. Autoimmune Disease
    1. Vasculitis
    2. Systemic Lupus
  8. Medial Temporal Sclerosis
  9. Metabolic
    1. Hypoglycemia
    2. Hyponatremia
    3. Hypocalcemia
    4. Hypernatremia
    5. Reduced calcium and magnesium levels increased risk of seizures
    6. Uremia
    7. Cirrhosis / Liver Failure
  10. Infection
    1. Meningitis
    2. Encephalitis
    3. Brain Abscess
  11. Medications
    1. Anti-psychotics - phenothiazines lower seizure threshhold more than butyrphenones
    2. Tricyclic antidepressants - particularly as overdose
    3. Lidocaine
    4. ß-Lactams - especially imipenam, high dose penicillin
    5. Meperidine (Demerol®) - metabolites are epileptogenic
    6. Theophylline
    7. Interferons - may increase risk of seizures, particularly in multiple sclerosis
    8. Tramadol (Ultram®) - only in overdoses >500mg
    9. Narcotic or benzodiazepine withdrawal
  12. Multiple Sclerosis - very rare cause
  13. Seizures in Elderly []
    1. Post-Stroke and Stroke Related
    2. Post-carotid endarterectomy hyperperfusion syndrome (1% of endarterectomy)
    3. Intracranial tumors
    4. Degenerative Disorders - mainly Alzheimer Dementia and Amyloid Angiopathy
    5. Metabolic - mainly hyperglycemia related
  14. Organ Transplantation
  15. Postoperative - anesthesia related, underlying systemic disease, organ failure
  16. Seizures are precipitated in many medical patients without clear seizure focus [2]

References

  1. Wallace SJ. 1997. Lancet. 349:1009 abstract
  2. Delanty N, Vaughan CJ, Freench JA. 1998. Lancet. 352(9125):383 abstract