Non-epileptic seizures

Any seizure is a cause of concern, but having a seizure by itself does not mean that a child has epilepsy. The following are examples of seizures that may not be associated with epilepsy.

• First seizures
• Febrile seizures (febrile convulsions)

Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Less commonly, the child becomes rigid or has twitches in only a portion of the body, such as an arm or a leg, or on the right or the left side only. Most febrile seizures last a minute or two; some can be as brief as a few seconds whilst others last for more than 15 minutes.

Children prone to febrile seizures are not considered to have epilepsy, since epilepsy is characterized by recurrent seizures that are not triggered by fever.

• Non-epileptic events (Non Epileptic Attack Disorder)

Sometimes young children and adolescents appear to have seizures, even though their brains show no seizure activity. This type of phenomenon has various names, including Non Epileptic Attack Disorder [NEAD], psychogenic seizures, and pseudo-epileptic seizures. These terms essentially mean something that looks like a seizure but is not.

The difference between epileptic seizures and NEAD is that epileptic seizures are accompanied by a change in brain activity, whereas NEAD is not.

NEAD may indicate dependence, a need for attention, avoidance of stressful situations, or specific psychiatric conditions, including personality disorders. Some young children and adolescents with epilepsy have NEAD in addition to their epileptic seizures. Others who have NEAD do not have epilepsy at all. NEAD cannot be treated in the same way as epileptic seizures. In fact, anti-epileptic treatment will not have an effect on NEAD. Instead, they are often treated by mental health specialists and with other medication but not Anti-Epileptic Drugs (AED’s).

Other non-epileptic events may be caused by narcolepsy (excessive daytime sleepiness, involuntary daytime sleep episodes and sudden loss of muscle tone), Tourette’s Syndrome (a neurological disease of unknown cause that presents with multiple tics [uncontrolled behaviour], snorting, sniffing, involuntary vocalisations and explosive utterance of obscenities), cardiac arrhythmia (abnormalities of heart rate or rhythm), and other medical conditions with symptoms that resemble seizures. Because symptoms of these disorders can look very much like epileptic seizures, they are often mistaken for epilepsy. There may be alteration in behaviour, some movement of limbs, and loss of consciousness. Distinguishing between true epileptic seizures and non-epileptic events can be very difficult and requires a good history of the seizures, and eyewitness accounts, thorough medical assessment, careful monitoring, and knowledgeable health professionals. Video-telemetry and EEG enable a diagnosis of non- epileptic events to be made.

• Eclamptic seizures (seizures which only occur in pregnancy, or soon after delivery).
• Fainting and syncope. A faint is distinguishable from a seizure in not having the following features: aura, tongue- biting, cyanosis, subsequent confusion, amnesia, or headache.