The Epilepsy Mimics and How They Differ From Epilepsy

Epilepsy affects the brain and causes recurrent seizures. It is characterized by many events of shaking and loss of consciousness. However, not all conditions with similar symptoms are epilepsy.

Meet Alex

Our patient today is “Alex”, a 25-year-old lady who presented with frequent events of shaking and loss of consciousness. She couldn’t drive, was hurting herself and mostly she couldn’t carry her 2-month-old baby. Alex had been diagnosed with epilepsy and was started on antiseizure medication. But there was no improvement and additionally, she was suffering from various side effects due to her medication.

Since she was not improving, she may not have epilepsy. Various conditions mimic epilepsy. Join me to find a proper diagnosis for Alex.

What are the Possible Causes?

A common condition that can cause symptoms similar to Alex’s is low blood sugar. Low blood sugar means our brain cells do not have enough energy to function efficiently. As the patient’s blood sugar drops, they can feel tired, dizzy, and even lose consciousness and have seizures. However, once the blood sugar rises these symptoms resolve. Blood sugar drops rapidly in diabetic patients who have taken insulin on an empty stomach. But Alex is not a diabetic nor on insulin, making low blood sugar an unlikely diagnosis.

Another option is complex migraine. Complex migraine starts with the patient feeling a migraine coming on. The migraine can be very severe and the patient can have weakness/numbness of one side of the body and loss of consciousness. When they regain consciousness, they have a very bad headache. Alex does not have a headache which makes this unlikely.

The psychogenic non-epileptic seizure is a specific diagnosis for people who have anxiety at the start, followed by shaking all over with their eyes closed. Patients are usually emotional during the event and they cry. The event lasts for longer than 5 to 10 minutes and they cannot respond to the actions of others during the event. Following the event, the patient has intact memory and can remember things done to them during the event (e.g.: if someone pinches them during the event, they can remember it). But Alex’s events do not last for 10 minutes making this condition an unlikely diagnosis.

For completeness’ sake let us consider epilepsy as well. Before an epileptic seizure, the patient can have an aura, a forewarning of the seizure. The aura is usually a weird feeling or feeling of the seizure coming on. The seizure starts with the turning of the head to one side or shaking of the arm. Then the shaking spreads throughout the whole body and the seizure is very intense. It is associated with frothing at the mouth and the person can have urinary or bowel incontinence. The seizure lasts for about 1-2 minutes and very rarely does it go beyond 2 minutes. After the seizure, the patient is tired, confused with no memory of the event. They have a gradual recovery. 

Diagnosis of a seizure is not always very straightforward. If you have symptoms similar to these, your doctor will have to run investigations on you to come to the correct diagnosis. If you have many events of shaking and loss of consciousness which are poorly controlled even with medication, it is important to visit an epilepsy center for a thorough work-up and diagnosis.

Involvement of the Heart

Let us look at another organ that could be causing Alex’s symptoms- the heart. The heart is controlled by electric impulses working in sync to contract the heart and pump blood. Sometimes these electrical impulses can go out of sync and cause erratic heartbeats called arrhythmias. Then the heart stops pumping blood correctly and there is less blood flow to the brain. As a result, the patients feel lightheaded, dizzy, they lose vision, and then they can faint/collapse. They can also have some shaking which is usually brief and happens after falling. When the heart and head are in the same plane, after collapsing, the brain recovers quickly. They wake up right away with no confusion or memory loss. 

When investigating Alex’s heart, sure enough an arrhythmia was found. She was put on treatment for it and her symptoms resolved. She was taken off all her epilepsy medication. Finally, she was able to hold her two-month-old without fear.

Let’s Summarize!

So, it is clear that not all episodes of shaking and loss of consciousness are epilepsy. There can be other conditions that mimic seizures. The following table shows the seizure mimics and how they differ from epilepsy.

This table shows the difference between epileptic seizure and other seizure mimics such as complex migraine, low blood sugar, syncope and psychological nonepileptic spells