Differential Diagnosis for First Seizure at 15 Years Old
Single Most Likely Diagnosis
- Benign Rolandic Epilepsy (BRE): This is a common cause of seizures in adolescents, characterized by focal seizures that often occur at night. It has a good prognosis and is typically outgrown by adulthood.
Other Likely Diagnoses
- Idiopathic Generalized Epilepsy (IGE): This includes several syndromes like juvenile myoclonic epilepsy, which often presents in adolescence with generalized seizures, myoclonic jerks, or absence seizures.
- Focal Epilepsy: Not otherwise specified, this can be due to various underlying causes such as hippocampal sclerosis, cortical dysplasia, or other structural abnormalities in the brain.
- Acute Symptomatic Seizures: These are seizures that occur in close temporal relationship to an acute systemic or CNS insult, such as infection, trauma, or intoxication.
Do Not Miss Diagnoses
- Central Nervous System (CNS) Infections: Such as meningitis or encephalitis, which can present with seizures and have a high morbidity and mortality if not promptly treated.
- Cerebral Venous Sinus Thrombosis: A rare cause of seizures, especially if associated with other symptoms like headache or focal neurological deficits.
- Brain Tumors: Although rare, they can present with seizures, especially if located in areas prone to epileptogenesis.
- Autoimmune Encephalitis: Conditions like NMDA receptor encephalitis can present with seizures among other psychiatric and neurological symptoms.
Rare Diagnoses
- Mitochondrial Diseases: Such as MELAS syndrome, which can present with seizures, among other systemic and neurological symptoms.
- Tuberous Sclerosis Complex (TSC): A genetic disorder that can cause seizures due to the development of cortical tubers.
- Rasmussen's Encephalitis: A rare inflammatory neurological disease, often presenting with seizures that are difficult to control, and progressive hemiparesis.
- Genetic Epilepsy Syndromes: Such as Dravet syndrome or Lennox-Gastaut syndrome, which are rare but important to consider due to their distinct management and prognosis.