Differential diagnosis of epilepsy and movement disorders

February 13, 2020
Specialities :

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.


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