Differentials
Daydreaming
SIGNS / SYMPTOMS
More likely to occur only during quiet, nonstimulating activities such as watching TV. No history of activity cessation. No unusual episodes induced by hyperventilation.
INVESTIGATIONS
EEG will be normal.
Attention deficit hyperactivity disorder (ADHD)
SIGNS / SYMPTOMS
More likely to occur only during quiet, nonstimulating activities such as watching TV. No history of activity cessation. No unusual episodes induced by hyperventilation.
INVESTIGATIONS
EEG will be normal. A variety of neuropsychological tests can help with formalizing diagnosis.
Complex partial epilepsy of frontal or temporal lobe origin
SIGNS / SYMPTOMS
Patients more likely to have eye deviation, facial twitching, or other localizing component at onset of seizure. Seizures typically last at least 30 seconds. There may be a preceding aura and a postictal state.
INVESTIGATIONS
EEG will be normal, asymmetric, or show focal epileptiform abnormality.
Psychogenic unresponsiveness/nonepileptic event
SIGNS / SYMPTOMS
Careful history will likely elicit characteristics of the unusual episode that are atypical for any kind of seizure. In some instances a social history may reveal a stressor that is precipitating these events.
INVESTIGATIONS
Routine EEG will be normal. It is often necessary to do prolonged video EEG monitoring to completely characterize the event and establish that there is no ictal electrographic abnormality.
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