Acute Alcohol Withdrawal-Related Seizures
Overview
Acute alcohol withdrawal–related seizures may be seen in people who have a history of excess alcohol consumption if they suddenly stop drinking.
- The peak incidence of seizures is around 36 hours
- Long-acting benzodiazepines and chlordiazepoxide are given in acute alcohol withdrawal to reduce the risk of seizures and reduce withdrawal symptoms
Febrile Convulsions
Overview
Febrile convulsions are seizures accompanied by fevers (>38°C) without signs of CNS infection typically in infants and children from 6 months to 5 years of age. They may be:
- Simple febrile seizures:
- Generalised tonic-clonic seizures that last <15 minutes and do not recur within 24 hours during the febrile illness
- Complex febrile seizures:
- Focal seizures or duration lasts <15 minutes, or recurs within 24 hours during the febrile illness
Psychogenic Non-Epileptic Seizures (Pseudoseizures)
Overview
Also known as non-epileptic attack disorder, and previously known as pseudoseizures, psychogenic non-epileptic seizures (PNES) describe the signs and symptoms seen in a patient that can be mistaken for epilepsy, but are not due to an epileptic disorder.
Non-epileptic seizures can be divided into:
- Organic:
- Includes syncope, endocrine disorders, transient ischaemic attacks etc.
- Psychogenic – can be further divided into:
- Dissociative seizures – involuntarily and unconsciously – most common
- Associated with psychiatric conditions that can cause seizures e.g. panic attacks
- Factitious seizures e.g. Münchhausen’s syndrome
Epidemiology
- PNES are commonly misdiagnosed as epilepsy
- PNES are more common in women
- Psychological stress often precedes PNES
Risk Factors
- Previous psychiatric history
- Examples are anxiety, depression, personality disorders etc.
- Psychological stresses
Presentation
It can be very challenging to differentiate between PNES and epilepsy. In some cases, both can co-exist. Features favouring PNES over epilepsy are:
- Duration >2 minutes
- Gradual onset
- Fluctuating course
- Violent movements and thrashing
- Lack of occurrence when alone
- Asynchronous movements
Features suggesting epilepsy are:
- Automatisms
- Incontinence
- Tongue-biting
Investigations
Blood tests for underlying causes:
- FBC
- Glucose
- U&Es
- Calcium
- LFTs
- Serum prolactin:
- This is usually raised in epilepsy and can be used to differentiate between PNES and epilepsy
- MRI – to rule out possible underlying pathology
- Video-EEG – gold-standard
Management
- Referral to psychiatry if PNES suspected
- Manage underlying cause
Complications
- Misdiagnosis of epilepsy and treatment given for epilepsy
