seizure mimics or imitators of epilepsy are those conditions that are not caused actually by the disturbances in the electrical activity of the brain. These conditions can cause loss of awareness, sensations, abnormal body movements. In reality, these symptoms mimic seizures. These conditions are often misdiagnosed as epilepsy. The following is a list of such conditions that imitate or mimic epilepsy or seizures’ like symptoms:
seizure mimics – syncope can cause seizures like symptoms and confusional state – which many people consider as seizures. A seizure provoked by syncope is called convulsive syncope. An experienced paediatric neurologist takes into consideration a typical clinical presentation and setting for syncope or fainting before diagnosing epilepsy – which may include any of the following:
- Low oxygen levels (hypoxia)
- Low blood sugar levels (hypoglycaemia)
- Interruption in blood circulation
These are literally very difficult epilepsy imitators (seizure mimics) – mostly psychological in nature. This type of seizures resembles epileptic seizures, but they are not real seizures as there is no clinical evidence or electrophysiological correlation with epilepsy. These are also known as pseudoseizures or psychogenic seizures or non-epileptic attacks. In this condition, subconscious stress causes the patient to have seizure-like episodes.
For the diagnosis of non-epileptic seizures, Video EEG is very helpful because expected EEG changes during the episode of seizure are usually absent in case of non-epileptic seizure. Treatment for pseudoseizures include medications for the treatment of underlying cause such as anxiety, depression and also behaviour modification therapy and psychological counselling.
This condition is common in pre-school children. A child begins crying and stops breathing – which appears to be silent crying. The child then becomes blue with deep cyanosis. After reaching this point the child breathes in or go into syncope with transient loss of consciousness.
Infants with Tetralogy of Fallot mostly have these spells, but children with pulmonary hypertension, ventriculoseptal defect, pulmonary stenosis and other congenital heart problems also have these spells. Hyper-cyanotic spells are associated with excessively deep breathing, rapid breathing, panic, crying and also clonic-tonic seizures episode.
Migraine and epilepsy co-exist in some cases. The visual aura associated with migraine can take several forms including the appearance of arcs of light flashes, greying out the visual field and blanking out. Sometimes more complex hallucinations or sensory perceptions that precede a headache or migraine are often misdiagnosed as seizures. Some children experience confusional spells with migraine.
Out of body experiences
During episodes of out of body experiences, a person feels as if they have lost immediate contact with his or her body. These are seen during childhood and adulthood. People with these conditions see themselves from above. This type of hallucinations manifests during anoxic seizures and migraines in some people.
Children have paroxysmal movement disorders such as nervous tics, opsoclonus-myoclonus syndrome, hyperekplexia, alternating hemiplegia, episodic ataxia, benign paroxysmal tonic upgaze, Paroxysmal nonkinesigenic dyskinesia, Paroxysmal kinesigenic dyskinesia and stereotypies are some of the forms of abnormal movement disorders which are often confused with epilepsy and seizures.
Many children and infants may demonstrate self-comforting movements or habits in sleep-wake transitions when they fall asleep. Exaggerated rhythmic movements include head banging, rolling and body rocking – which may be sometimes associated with noise. A healthy sleep routine, good sleep habits and hygiene may help in resolving this issue. If such events appear to be repeatedly happening throughout the night, then frontal lobe epilepsy may be suspected. A video EEG is helpful in diagnosing the real cause.
Other imitators of epilepsy include vertigo, Benign paroxysmal vertigo, cardiac arrhythmias, transient ischemic attacks (TIAs), Paroxysmal extreme pain disorder, Episodic ataxias, Paroxysmal Movement Disorders, REM sleep disorders, periodic leg movements, Benign neonatal sleep myoclonus, parasomnias, sleep-related rhythmic movement disorders, tantrums and rage reactions, daydreaming and inattention
Seizure mimics or epilepsy imitators are very difficult to diagnose as distinguishing them from seizures become difficult. Many children and adults keep on taking antiepileptic drugs for years together inappropriately for problems that are actually not seizures and never be seizures.
For detecting such problems, a comprehensive neurological examination and evaluation should be supplemented by neuropsychiatric and neuropsychological testing – using a multidisciplinary approach.