Exercise Caution in Diagnosing Epilepsy, Expert Advises

   Epilepsy is the second most important neurological disease worldwide and common in the developing world, according to an expert speaking  at Internal Medicine 2011, the annual meeting of the American College of Physicians in San Diego.

   But watch how you diagnose. “Be very careful about writing the word ‘epilepsy’ in anybody’s record until they are an epileptic,” said Martin Samuels, MD, chairman of the department of neurology at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard.

   Being diagnosed as an epileptic can affect a patient’s access to insurance and employment. State laws vary on how long a patient must be seizure-free before he or she can drive. And patients should not bathe babies or engage in potentially dangerous activities.

   Ten percent of Americans will have a seizure at some point in their lives and for three percent they will be recurring, Dr. Samuels told attendees. Etiology varies with age. Developmental, traumatic, and infectious causes are more common among children and other young people; among the elderly the most common etiology is cerebrovascular disease.

   In addition to assessing the cause of a seizure, physicians should determine whether the event was partial or generalized. A partial seizure results from a malfunction in a single part in the brain. Therefore, its manifestation can be in any function controlled by that part of the brain. Generalized seizures can affect the entire brain and are associated with a loss of consciousness. But that sometimes can last so briefly that it’s not apparent.

   According to Dr. Samuels, even in cases where consciousness is obviously lost, there are a number of differential diagnoses to consider. Syncope is usually preceded by feelings of dizziness or faintness and episodes are shorter than seizures. Neither is incontinence an absolute epileptic seizure symptom. A patient with epilepsy may have an empty bladder, or a person with a psychogenic non-epileptic seizure may be deliberately incontinent, he said.

   Psychogenic non-epileptic seizures are challenging to deal with, Dr. Samuels said. “It’s not much better than having epilepsy. You still fall down, embarrass yourself, can’t drive,” he explained. Such seizures are more common in women, and do occur in some people who also have epilepsy.

   There are a number of therapeutic agents, including a new generation of anticonvulsants. But “Pharmacologically treating every seizure doesn’t make sense,” Dr. Samuels said. For example, if a patient has suffered a seizure due to alcohol withdrawal, anti-epileptic medications could do more harm than good.