Nonepileptic |
Psychogenic | — | Childhood trauma High frequency of seizures History of self-harm Medically unexplained symptoms Physical or sexual abuse Posttraumatic stress disorder Psychiatric disease Resistance to antiepileptic drugs
| | Consistent triggers unusual for epilepsy (e.g., stress, pain, particular sounds) Duration longer than two minutes Eyes closed during event Gradual seizure onset Pelvic thrusting Sobbing, moaning, or coughing during event Usually occurs in public
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Syncope | | | Arrhythmias (electrocardiography, Holter monitoring) Carotid bruit or heart murmur Male sex Middle to older age Positive tilt table test Precipitated by carotid massage
| Preceded by lightheadedness, diaphoresis, or palpitations Precipitated by exercise, urination, stress, blood draws, or prolonged sitting or standing
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Epileptic |
Provoked (acute symptomatic; caused by underlying disease or event) | Acute hemorrhagic stroke Acute ischemic stroke Acute venous thrombosis Central nervous system infection or tumor Drug intoxication or withdrawal Intracranial hematoma Medication use Metabolic derangements Newly diagnosed brain lesion (abscess, tumor, or vascular malformation) Recent head trauma Toxic exposures
| Alcohol use Diabetes mellitus Drug use Focal transient motor or sensory symptoms Human immunodeficiency virus infection or hepatitis Hyperlipidemia Liver or kidney disease Personality disturbances Prior or active cancer Prior transient ischemic attack or stroke Progressive headaches Recent new medication Recent toxic exposures Recent trauma Severe dehydration
| Age younger than one year or older than 65 years Male sex Physical examination may show confusion, fever, signs of infection, neck stiffness, pupil asymmetry, speech difficulties, unilateral sensory loss, unilateral weakness, nausea, vomiting
| Duration less than two minutes Eyes open during event Focal seizure with or without secondary generalization Head turning Ictal cry (preseizure stereotypical shout) Occurs during sleep Synchronous bilateral movements
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Unprovoked | | | | |
| Perinatal injury Remote stroke Remote trauma
| Cerebral palsy Family history of seizure Maternal preeclampsia Mental retardation No suggestive history Old head injury Perinatal stroke or ischemia Prior transient ischemic attack or stroke
| Age younger than one year or older than 65 years Focal neurologic deficit (new or chronic) Male sex Physical examination may show minor injuries, scalp lacerations, subgaleal bruising, lateral tongue lacerations, evidence of incontinence
| Duration less than two minutes Eyes open during event Focal seizure with or without secondary generalization Head turning Ictal cry (preseizure stereotypical shout) Occurs during sleep Synchronous bilateral movements
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| Degenerative disorder Movement disorder Tumor
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