Medical Faculty, Johannes Kepler University, Linz, Austria, Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Linz, Austria.
Department of Clinical Neurophysiology, Necker Enfants Malades Hospital, AP-HP, Paris, France.
Epileptic Disord. 2020 Dec 1;22(6):716-738. doi: 10.1684/epd.2020.1234.
The first and most important step in establishing diagnosis of epilepsy consists of careful history taking from patients and witnesses. The clinical evaluation of the event will lead the indication for further diagnostic tests including e.g. EEG and MRI. Hence, identifying the paroxysmal event as epileptic or non-epileptic is the very first step in the diagnostic process. Paroxysmal events pose a clinical challenge, as these are unpredictable and do not usually occur in the doctor's office. History taking, hunting for witness reports and home-video recordings are the main tools to conclude whether a paroxysmal event is a seizure or not. In this review, we describe the most common differential diagnoses of epileptic seizures, including syncope, psychogenic non-epileptic seizures, as well as a variety of paroxysmal conditions and behaviours of all age groups. Misdiagnosis of non-epileptic events as epilepsy may not only defer the correct diagnosis and treatment but also poses additional risk by prescribing antiepileptic drugs unnecessarily. Moreover, missing the diagnosis of epilepsy implies risk of additional seizures and therefore possibly injuries, sudden death in people with epilepsy, or status epilepticus. Studies have shown that patient and witness accounts are unreliable in a high percentage of cases. Therefore, the core competency of doctors and medical professionals assessing paroxysmal events is knowledge of the clinical features that help define the different aetiologies, thus empowering them to establish the most accurate appraisal of an event. [Published with video sequences].
癫痫诊断的第一步也是最重要的一步，是仔细向患者和目击者询问病史。对事件的临床评估将提示进一步进行诊断测试，包括脑电图和 MRI 等。因此，确定阵发性事件是癫痫发作还是非癫痫发作是诊断过程中的第一步。阵发性事件构成了临床挑战，因为这些事件是不可预测的，通常不会在医生的办公室发生。病史采集、寻找目击者报告和家庭录像记录是得出阵发性事件是否为癫痫发作的主要工具。在这篇综述中，我们描述了癫痫发作最常见的鉴别诊断，包括晕厥、心因性非癫痫性发作，以及各种阵发性疾病和所有年龄段的行为。将非癫痫性事件误诊为癫痫不仅会延迟正确的诊断和治疗，而且还会因不必要地开处方抗癫痫药物而带来额外的风险。此外，漏诊癫痫意味着可能会出现更多的癫痫发作，从而导致受伤、癫痫患者的猝死或癫痫持续状态。研究表明，在很大比例的病例中，患者和目击者的陈述是不可靠的。因此，评估阵发性事件的医生和医疗专业人员的核心能力是了解有助于定义不同病因的临床特征，从而使他们能够对事件进行最准确的评估。[附有视频序列]。
