Diagnosis of Epilepsy and Related Episodic Disorders

Erik K. St. Louis, MD, MS, FAAN; Gregory D. Cascino, MD, FAAN Epilepsy p. 15-37 February 2016, Vol.22, No.1 doi: 10.1212/CON.0000000000000284
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Purpose of Review: This review identifies the diverse and variable clinical presentations associated with epilepsy that may create challenges in diagnosis and treatment.

Recent Findings: Epilepsy has recently been redefined as a disease characterized by one or more seizures with a relatively high recurrence risk (ie, 60% or greater likelihood). The implication of this definition for therapy is that antiepileptic drug therapy may be initiated following a first seizure in certain situations.

EEG remains the most commonly used study in the evaluation of people with epilepsy. Routine EEG may assist in diagnosis, classification of seizure type(s), identification of treatment, and monitoring the efficacy of therapy. Video-EEG monitoring permits seizure classification, assessment of psychogenic nonepileptic seizures, and evaluation of candidacy for epilepsy surgery. MRI is pivotal in elucidating the etiology of the seizure disorder and in suggesting the localization of seizure onset.

Summary: This article reviews the new International League Against Epilepsy practical clinical definition for epilepsy and the differential diagnosis of other physiologic paroxysmal spells, including syncope, parasomnias, transient ischemic attacks, and migraine, as well as psychogenic nonepileptic seizures. The initial investigational approaches to new-onset epilepsy are considered, including neuroimaging and neurophysiologic investigations with interictal and ictal video-EEG. Neurologists should maintain a high index of suspicion for epilepsy when children or adults present with a single paroxysmal spell or recurrent episodic events.

Address correspondence to Dr Gregory D. Cascino, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, [email protected].

Relationship Disclosure: Dr St. Louis receives research support from the Mayo Foundation and the National Institutes of Health. Dr Cascino serves on the board of directors of the American Academy of Neurology and as an associate editor of Neurology. Dr Cascino receives royalties from Mayo Medical Ventures and UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Drs St. Louis and Cascino report no disclosures.

© 2016 American Academy of Neurology