Appendix D: Differential diagnosis of epilepsy in children, young people and adults Differential diagnosis of epilepsy in adults CG137 NICE guideline appendix D 1 of 4 • Epilepsy • Syncope with secondary jerking movements • Primary cardiac or respiratory abnormalities, presenting with secondary anoxic seizures • Involuntary movement disorders and other neurological conditions • Hyperekplexia • Non-epileptic attack disorder (NEAD) • Epilepsy • Cardiovascular • Movement disorders • Brainstem, spinal, or lower limb abnormalities • Cataplexy • Generalised convulsive movements • Metabolic disorders • Idiopathic drop attacks • Drop attacks • Vertebrobasilar ischaemia Abnormal movements • Transient focal motor attacks • Focal motor seizures predominate • Tics • Transient cerebral ischaemia • Facial muscle and eye movements • Tonic spasms of multiple sclerosis • Paroxysmal movement disorders • Episodic phenomena in sleep • Partial seizures • Movement disorders • Other neurological disorders • Normal physiological movements • Frontal lobe epilepsy • Other epilepsies • Pathological fragmentary myoclonus • Restless leg syndrome • Non REM/REM parasomnias • Sleep apnoea • Other movements in sleep • Syncope • Epilepsy • Cardiac disorders • Microsleeps • Panic attacks • Hypoglycaemia • Other neurological disorders • Non-epileptic attack disorder (NEAD) • Loss of awareness • Somatosensory attacks: epileptic seizure, transient ischaemic attack, hyperventilation Disturbed • Transient vestibular symptoms: peripheral vestibular disease, epilepsy • Visual symptoms: migraine, transient ischaemic attack, epilepsy awareness, • Transient focal sensory attacks thoughts, • Psychic experiences • Epilepsy and • Migraine sensations • Panic attacks • Aggressive or vocal outbursts • Drug induced flashbacks predominate • Hallucinations or illusions caused by loss of a primary sense • Prolonged confusional or fugue states • Psychotic hallucinations and delusions • Non-epileptic attack disorder (NEAD) • Related to learning disability • Epilepsy • Volitional • Acute encephalopathy • Nonconvulsive status epilepticus • Intermittent psychosis • Transient global amnesia • Hysterical fugue CG137 NICE guideline appendix D 2 of 4 Differential diagnosis of epilepsy in children and young people CG137 NICE guideline appendix D 3 of 4 INFANT • Cardiac arrhytthmias • Parasomnias • Hyperexplexia • Sleep myoclonus • Structural cardiac lesion • Benign myoclonus of infancy • Paroxysmal dystonia • GOR • Sandifers syndrome/GOR What is the trigger • Sandifer syndrome • Benign paroxysmal torticollis for the attack? • Alternating hemiplegia • Only during sleep? • Febrile convulsions • (Infantile spasms) • Self gratification behaviour • Related to feeding? • Paroxysmal dystonias/dyskinesias • Shuddering attacks • With a fever? • Benign sleep myoclonus • Cataplexy • On initiation of movement? • Overflow movements • With excitement/emotion? TODDLER • Shuddering attacks • Cardiac arrhytthmias • Following unpleasant/painful • Reflex anoxic seizures stimuli? • Reflex anoxic seizures • Cyanotic breath-holding attacks History of Event / Attack • Boredom/concentration • Hyperekplexia • Cyanotic breath-holding attacks • Myoclonus • Frequency • Paroxysmal dyskinesias • Timing •Daydreaming • Sandifer syndrome • Benign paroxysmal vertigo/torticollis • Triggers • Cardiac arrhythmias • Migraine • Cataplexy • Warning beforehand • Neurocardiogenic syncope • Akinetic (drop) attacks What is the • Reflex anoxic seizures • Colour change • (Febrile convulsions) colour change? • Overflow movements • Alteration in conscious level • Pallor • Structural cardiac lesion • Self gratification behaviour • Motor phenomena • Stereotypies/ritualistic behaviour (eg. Children with • Cyanosis • Cyanotic breath-holding attack learning difficulties) • Duration of attack • Flushing • Gastro-oesophageal reflux • Head banging • Confusional arousal • Symptoms following attack • Night terrors • Self gratification behaviour • Infantile spasms OLDER CHILD • Benign myoclonus of infancy • Cardiac arrhytthmias • Facial tics • Neurocardiogenic syncope • Reflex anoxic seizures • Focal seizure • Neurocardiogenic syncope • Behavioural stereotypes • Hyperexplexia • Myoclonus What is the predominant • Hyperekplexia motor phenomenon? • TICs • Paroxysmal dyskinesias • Repetitive stereotyped spasm? • Cardiac arrhythmias • Benign paroxysmal vertigo/torticollis • Hypertonia? • Syncope • Migraine • Eye movement disorders • Hypotonia (include FALLS)? • Cata-plexy • Episodic ataxia • Dystonia? • Akinetic (drop) attacks (usually only • Cataplexy with other seizure types) • Akinetic (drop) attacks • Unsteadiness? • Day dreams • Benign paroxysmal torticollis • Hyperventilation panic/anxiety attacks • Non epileptic attack disorder • Paroxysmal dystonia / dyskinesia • Pseudo-syncope or psychogenic syncope • Drug reactions • Stereotypes/ritualistic behaviour (eg. Children with learning difficulties) • Benign paroxysmal vertigo • Confusional arousal • REM sleep disorders • Episodic ataxia • Night terrors • Tumour (posterior fossa) • Periodic paralyses CG137 NICE guideline appendix D 4 of 4 .