Posttraumatic Epilepsy Differential Diagnoses

Updated: Dec 06, 2017
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Diagnostic Considerations

If a case of posttraumatic epilepsy (PTE) demonstrates atypical features and the seizures continue despite treatment, consider the possibility of pseudoseizures. Hudak et al found that in patients with refractory PTE following moderate traumatic brain injury, about 20-30% proved to have psychogenic attacks. [12] This percentage is similar to that in patients with seizures after nontraumatic brain injury. With severe TBI, some patients have posttraumatic stress disorder, which can contribute to pseudoseizures.

Therefore, in intractable epilepsy patients, the diagnosis should be verified by video-EEG monitoring, which shows that the nature of the seizures is psychogenic rather than epileptic. Some frontal lobe seizures may have bizarre features, so caution should be used if basing the decision solely on clinical features. Video-EEG is very helpful in these patients for distinguishing true epileptic from nonepileptic seizures; for those with epileptic seizures, it may allow further workup for epilepsy surgery or vagus nerve stimulation.

Differential Diagnoses