Differential Diagnosis for Seizure

The following is a differential diagnosis for seizure, categorized for clarity and emphasis on critical considerations.

• Single Most Likely Diagnosis

  • Epilepsy: This is the most common cause of seizures, characterized by recurrent episodes due to abnormal electrical activity in the brain. The likelihood of epilepsy as a diagnosis increases with a history of previous seizures, especially if there's a known seizure disorder or a family history of epilepsy.

• Other Likely Diagnoses

  • Syncope: Often mistaken for seizures, syncope (fainting) can present with convulsive movements and loss of consciousness. However, it typically lacks the post-ictal phase seen in seizures.
  • Migraine: Certain types of migraines, especially those with aura, can mimic seizure activity, including visual disturbances and transient neurological symptoms.
  • Psychogenic Non-Epileptic Seizures (PNES): These are events that resemble epileptic seizures but are not caused by abnormal electrical brain activity. Instead, they are psychological in origin, often related to stress, trauma, or mental health conditions.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common, seizures can be the presenting symptom of a stroke or TIA, especially in older adults. Missing this diagnosis could lead to significant morbidity or mortality.
  • Meningitis or Encephalitis: Infections of the brain or meninges can cause seizures among other symptoms like fever, headache, and altered mental status. Prompt diagnosis and treatment are crucial to prevent serious complications or death.
  • Hypoglycemia: Low blood sugar can cause seizures, especially in diabetic patients. This condition is easily treatable but can be fatal if not recognized promptly.
  • Hyperthermia: Elevated body temperature, often due to environmental exposure or infection, can lead to seizures. This condition requires immediate attention to lower the body temperature and address the underlying cause.

• Rare Diagnoses

  • Autoimmune Encephalitis: A group of conditions that occur when the body's immune system mistakenly attacks healthy brain cells, leading to inflammation of the brain. Seizures are a common presenting symptom.
  • Vitamin Deficiencies: Certain vitamin deficiencies, such as those involving vitamin B6 or B12, can rarely cause seizures.
  • Parasitic Infections: Infections like neurocysticercosis (caused by the pork tapeworm) can lead to seizures, especially in individuals from or traveling to endemic areas.