Differential diagnosis of epilepsy and movement disorders | Ukrainian Medical Journal

Litovchenko T.A.

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Differential diagnosis of epilepsy and movement disorders

Differential diagnosis of epilepsy and movement disorders

February 13, 2020

1019

Neurology and Psychiatry

Litovchenko T.A.

Keywords :

differential diagnosis,

Specialities :

Neurology and Psychiatry

Resume

Diagnosis of paroxysmal conditions in neurology is one of the most difficult problems. Particular difficulties are caused by the differential diagnosis of epileptic and non-epileptic paroxysmal disorders, given the absence of absolutely reliable clinical markers of the disease during the inter-paroxysmal period, not always sufficient informative instrumental methods of research and insufficient awareness of doctors. Non-epileptic paroxysmal disorders are misdiagnosed as epilepsy in 20–30% of cases, even in third-level medical centers. False positive diagnosis of epilepsy is observed in 2–71% of cases. Movement disorders characterized by sudden episodes of transient abnormal motor activity, such as chorea, athetosis, none-epileptic myoclonus, dystonia, paroxysmal dyskinesia, loss of coordination of voluntary motor acts or combination of infringement coordination and involuntary motor activity represent a significant diagnostic difficulties even for highly qualified professionals. There are no absolutely pathognomonic signs of epileptic and non-epileptic seizures. The article presents the basic clinical and neurophysiological criteria for differential diagnosis of epilepsy and some movement disorders. Approaches to treatment of patients with epileptic seizures who need to be differentiated with paroxysmal motor disorders have several features. After the diagnosis of «Epilepsy» prescribing broad-spectrum anti-epileptic drugs that do not have adverse effects on cognitive function and do not require prolonged dose titration. In such cases, the drug of choice may be levetiracetam, which is effective in most epileptic seizures, can be used effectively in adult and pediatric practice, does not cause seizure attacks, has minimal side effects, can be prescribed immediately at therapeutic doses, in addition effective in a number of movement disorders and in combination of epilepsy with movement disorders.

References:

Temin P.A., Nikanorova M.Yu. (Eds.) (1999) Epilepsy and convulsive syndromes in children. Medicine, Moscow, 656 p.
Alsaadi T.M., Thieman C., Shatzel A., Farias S. (2004) Video-EEG telemetry can be a crucial tool for neurologists experienced in epilepsy when diagnosing seizure disorders. Seizure, 13(2004): 32–34. doi: 10.1016/S1059-1311(03)00072-4
Baizabal-Carvallo J.F., Hallett M., Jankovic J. (2019) Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiol. Dis., 127: 32–44. doi: 10.1016/j.nbd.2019.02.013.
Betts T., Boden S. (1992) Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I. Seizure, 1(1992): 19–26. doi: 10.1016/1059-1311(92)90050-B
Chatterjee A., Louis E.D., Frucht S. (2002) Levetiracetam in the treatment of paroxysmal kinesiogenic choreoathetosis. Mov. Disord., 17: 614–615.
Chitre M. (2013) Pitfalls in the diagnosis and misdiagnosis of epilepsy. Paediatr. Child Health (United Kingdom), 23: 237–242.
Chowdhury F.A., Nashef L., Elwes R.D. (2008) Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty. Eur. J. Neurol., 15: 1034–1042.
Dalla Bernardina B. (2009) Benign myoclonus of early infancy or Fejerman syndrome. Epilepsia, 50(5): 1290–1292. doi: 10.1111/j.1528-1167.2009.02154.x.
Ebada M.A., Alkanj S., Ebada M. et al. (2019) Safety and efficacy of levetiracetam for the management of levodopa-induced dyskinesia in patients with Parkinson’s disease: a systematic review. Mar. 13 [Epub. ahead of print].
doi: 10.2174/1871527318666190314101314.
Edfors R., Erdal J., A-Rogvi-Hansen B. (2008) Tilt table testing in patients with suspected epilepsy. Acta Neurol. Scand., 117(2008): 354–358. doi: https://doi.org/10.1111/j.1600-0404.2007.00954.x.
Faulkner H.J., Arima H., Mohamed A. (2012) The utility of prolonged outpatient ambulatory EEG. Seizure, 21(2012): 491–495. doi: 10.1016/j.seizure.2012.04.015.
Fisher R.S., Scharfman H.E., deCurtis M. (2014) How can we identify ictal and interictal abnormal activity? Adv. Exp. Med. Biol., 813: 3–23. doi: 10.1007/978-94-017-8914-1_1.
Gates J.R. (2002) Nonepileptic seizures: classification, coexistence with epilepsy, diagnosis, therapeutic approaches, and consensus. Epilepsy Behav., 3(1): 28–33. doi: https://doi.org/10.1006/ebeh.2001.0310.
Gibbs J., Appleton R.E. (1992) False diagnosis of epilepsy in children. Seizure, J. Br. Epilepsy Assoc., 1(1992): 15–18. doi: 10.1016/1059-1311(92)90049-7.
Greenland J.C., Barker R.A. (Eds.) (2018) The differential diagnosis of Parkinson’s disease. In: T.B. Stoker, J.C. Greenland (Eds.) Parkinson’s disease: pathogenesis and clinical aspects. Codon Publications, Brisbane (AU), Chapter 6.
Hamid T., Rose S., Clifford A. et al. (2009) 1 in 8 patients with syncope are misdiagnosed as epilepsy on long-term cardiac rhythm monitoring by an implantable ECG looprecorder (ILR). Epilepsia, 50(2009): 35.
Hovorka J., Nežádal T., Herman E. et al. (2007) Psychogenic non-epileptic seizures, prospective clinical experience: diagnosis, clinical features, risk factors, psychiatric comorbidity, treatment outcome. Epileptic Disord., 9(2007): S52–S58. doi: 10.1684/epd.2008.0156.
ILAE (1997) ILAE commission report. The epidemiology of the epilepsies: future directions. International League Against Epilepsy. Epilepsia, 38(5): 614–618.
ILAE (2019) Epilepsy imitators (https://www.epilepsydiagnosis.org/epilepsy-imitators).
Josephson C.B., Rahey S., Sadler R.M. (2007) Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy. Can. J. Neurol. Sci., 34(2007): 221–224. doi: 10.1017/S0317167100006089.
Imbrici P., D’Adamo M.C., Cusimano A., Pessia M. (2007) Episodic ataxia type 1 mutation F184C alters Zn²⁺-induced modulation of the human K⁺ channel Kv1.4-Kv1.1/Kvbeta1.1. Am. J. Physiol. Cell Physiol., 292(2): C778–C787. doi: 10.1152/ajpcell.00259.2006.
Kamble N.L., Pal P.K. (2016) Electrophysiological evaluation of psychogenic movement disorders. Parkinsonism Relat. Disord., Suppl. 1: S153–S158. doi: 10.1016/j.parkreldis.
Karacan M., Bidev D., Olgun H. et al. (2010) Cardiac or vasovagal syncope misdiagnosed as idiopathic epilepsy. Guncel. Pediatr., 8(2010): 94–99.
Kato N., Sadamatsu M., Kikuchi T. et al. (2006) Paroxysmal kinesigenic choreoathetosis: from first discovery in 1892 to genetic linkage with benign familial infantile convulsions. Epilepsy Res., 70(Suppl. 1): S174–S184.
King D.W., Gallagher B.B., Murvin A.J. et al. (1982) 3rd pseudoseizures: diagnostic evaluation. Neurology, 32(1982): 18–23.
Kutlu G., Erdal A., Gomceli Y.B., Inan L.E. (2013) Pseudo-refractory epilepsy. Neurosciences, 18(2013): 284–286.
Labiner D.M., Chong J. (2009) Under counting epilepsy: finding the undiagnosed along the Arizona-Mexico border. Epilepsia, 50(2009): 416–417.
LaRoche S., Taylor D., Walter P. (2011) Tilt table testing with video EEG monitoring in the evaluation of patients with unexplained loss of consciousness. Clin. EEG Neurosci., 42(2011): 202–205. doi: https://doi.org/10.1177/155005941104200311.
Leach J., Lauder R., Nicolson A., Smith D. (2005) Epilepsy in the UK: misdiagnosis, mistreatment, and undertreatment? The Wrexham area epilepsy project. Seizure, 14(2005): 514–520. doi: 10.1016/j.seizure.2005.08.008.
McCluggage J.R., Ramsey H.C., Irwin W.G., Dowds M.F. (1984) Anticonvulsant therapy in a general practice population in Northern Ireland. J.R. Coll. Gen. Pract., 34(1984): 24–31.
Miakotnykh V.S. (1990) Errors in the differential diagnosis of different types of nonepileptic paroxysms in the initial period of their occurrence. Zhurn. Nevropatol. Psikhiatr. im. S.S. Korsakova, 90(1990): 13–18.
NICE (2004) The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care (https://www.nice.org.uk/guidance/cg20).
Ohmori I., Ohtsuka Y., Ogino T. et al. (2002) The relationship between paroxysmal kinesigenic choreoathetosis and epilepsy. Neuropediatrics, 33: 15–20.
Panayiotopoulos C.P. (2010) A clinical guide to epileptic syndromes and their treatment. Springer-Verlag, London, 578 p. doi: 10.1007/978-1-84628-644-5.
Parra J., Iriarte J., Kanner A.M. (1999) Are we overusing the diagnosis of psychogenic non-epileptic events? Seizure, 8(1999): 223–227. doi: 10.1053/seiz.1999.0285.
Pringsheim T., Doja A., Gorman D. et al. (2012) Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. Can. J. Psychiatry, 57: 133–143.
Rangel I., Freitas J., Correia A.S. et al. (2014) The usefulness of the head-up tilt test in patients with suspected epilepsy. Seizure, 23(2014): 367–370. doi: 10.1016/j.seizure.2014.02.004.
Roessner V., Plessen K.J., Rothenberger A. et al. (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur. Child Adolesc. Psychiatry, 20: 173–196.
Scheepers B., Clough P., Pickles C. (1998) The misdiagnosis of epilepsy: findings of a population study. Seizure, 7(1998): 403–406. doi: 10.1016/S1059-1311(05)80010-X.
Smith D., Defalla B.A., Chadwick D.W. (1999) The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. QJM Mon. J. Assoc. Phys., 92(1999): 15–23.
Smith P.E., Myson V., Gibbon F. (2002) A teenager epilepsy clinic: observational study. Eur. J. Neurol., 9(2002): 373–376. doi: 10.1046/j.1468-1331.2002.00418.x.
Stroink H., Van Donselaar C.A., Geerts A.T. et al., W.F.M. Arts (2003) The accuracy of the diagnosis of paroxysmal events in children. Neurology, 60(2003): 979–982. doi: https://doi.org/10.1212/01.WNL.0000049914.25434.72.
Tsai J.D., Chou I.C., Tsai F.J. et al. (2005) Clinical manifestation and carbamazepine treatment of patients with paroxysmal kinesigenic choreoathetosis. Acta Paediatr. Taiwan, 46(3): 138–142.
Uldall P., Alving J., Hansen L.K. et al. (2006) The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events. Arch. Dis. Child, 91(2006): 219–221. doi: http://dx.doi.org/10.1136/adc.2004.064477.
Viteva E.I., Zahariev Z.I. (2009) Pseudoresistance in patients with epilepsy — characteristics and determining factors. Folia Med. (Plovdiv), 51(2009): 33–39.
Wolters E., Baumann C. (Eds.) (2014) Parkinson disease and other movement disorders. VU University Press, 832 p.
Wolz M., Löhle M., Strecker K. et al. (2010) Levetiracetam for levodopa-induced dyskinesia in Parkinson’s disease: a randomized, double-blind, placebo-controlled trial. J. Neural. Transm. (Vienna), 117(11): 1279–1286. doi: 10.1007/s00702-010-0472-x.
Xu Y., Nguyen D., Mohamed A. et al. (2016) Frequency of a false positive diagnosis of epilepsy: a systematic review of observational studies. Seizure, 41: 167–174. doi: 10.1016/j.seizure.2016.08.005.
Yogarajah M., Powell H.W., Heaney D. et al. (2009) Long term monitoring in refractory epilepsy: the Gowers Unit experience. J. Neurol. Neurosurg. Psychiatry, 80(2009): 305–310. doi: http://dx.doi.org/10.1136/jnnp.2008.144634.
Zaidi A., Clough P., Cooper P. et al. (2000) Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J. Am. Coll. Cardiol., 36(2000): 181–184. doi: http://dx.doi.org/10.1136/heart.83.2.181.