Epileptic versus Nonepileptic Seizures

Misdiagnosis of other entities as epilepsy leads to social stigma, a failure to recognize and treat the true underlying pathology, and the unwarranted risk and expense of antiepileptic drugs. Because epilepsy is a chronic condition requiring continuous treatment for a substantial time, misdiagno-sis can result in unnecessary long-term phar-macologic treatment. Paradoxically, in underdeveloped communities where neurologic care is substandard relative to developed regions, the misdiagnosis of epilepsy is frequent and the patient may be at a lesser risk of iatrogenic harm when managed by "traditional healers." Of course, neither situation is acceptable, and the remainder of this chapter will discuss ways to improve neurologic care through an appropriate diagnosis of epilepsy. Refer to Chapter 2 for a detailed discussion of the differential diagnosis of


■ It is common in developing countries for generalized tonic-clonic seizures to be the only ictal event of particular concern to individuals and their families. Consequently, a patient presenting with a single generalized tonic-clonic seizure does not necessarily have an acute condition. Partial seizures may have occurred but were not recognized as such.


■ The possibility that epileptic seizures may be secondary to some acute or subacute, yet treatable, cerebral insult must be kept in mind by physicians practicing in developing countries.

■ Seizures that do not have generalized tonic-clonic components are often not recognized as epileptic.

■ Open and interactive discussion during the consultation is also important as a teaching tool for both the patient and relatives. It is essential that the patient and family members have a simplified understanding of the specific behaviors that the doctor considers to be a seizure, for purposes of clinical follow-up.

epilepsy and nonepileptic entities, particularly those that are common in developing countries.

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