Epilepsy: getting the diagnosis right

All that convulses is not epilepsy

Epilepsy may present with a variety of symptoms, and other conditions may mimic its manifestations. The diagnosis is almost always based solely on the clinical history. It is therefore not surprising that diagnostic accuracy remains a major problem.1 About a fifth of patients referred to specialist units with “intractable epilepsy” are found, on further assessment, not to have epilepsy.2 It is also common for patients to have symptoms for months or even years before epilepsy is diagnosed. Thus, it is important to be aware of both the heterogeneous and sometimes subtle forms of epilepsy and of the alternative diagnoses.3

The differential diagnosis of epilepsy includes all causes of transient loss of awareness, falls, paroxysmal sensory-motor phenomena, and generalised convulsive movements which are the most common presenting symptom of epilepsy.3 Tonic-clonic seizures (“a convulsion”) start with sudden loss of awareness, a guttural cry, generalised stiffening of the body and limbs, followed by rhythmic jerking of the limbs, often associated with …