Neurológia pre prax 5/2010

Diagnostic and indication errors in epilepsy treatment

Diagnostic and indication errors are analysed. Differential diagnoses between epileptic and organic non-epileptic seizures comprise syncopes, myoclonus, extrapyramidal disorders, transient global amnesia, metabolic and endocrine breakdown, and parasomnias. Syncopes often present with motor symptoms – myoclonic jerks, tonic limb extension or flection, orofacial movements, and open eyes. Cortical provoked myoclonus is encountered in encephalopaties. Paroxysmal kinesigenic dyskinesias constitute a serious diagnostic problem. Symptoms of transient global amnesia may be caused by non-convulsive epileptic status. Differences between nocturnal frontal lobe seizures and parasomnias are thoroughly discussed. Main indication errors are: late referrals to epilepsy centers, not performing complex re-evaluation in resistant patients after 4–6 years, and belated vagus nerve stimulator indication.

Keywords: epilepsy, syncope, myoclonus, paroxysmal kinesigenic dyskinesia, transient global amnesia, parasomnia.