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By: Mazen Al-Hakim, M.D.. Seizure Mimics * A-clinical: -Syncope -“Pseudo-seizures” -Sleep disturbances -Hyperventilation -Metabolic * B. EEG Misreading.

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Presentation on theme: "By: Mazen Al-Hakim, M.D.. Seizure Mimics * A-clinical: -Syncope -“Pseudo-seizures” -Sleep disturbances -Hyperventilation -Metabolic * B. EEG Misreading."— Presentation transcript:

1 By: Mazen Al-Hakim, M.D.

2 Seizure Mimics * A-clinical: -Syncope -“Pseudo-seizures” -Sleep disturbances -Hyperventilation -Metabolic * B. EEG Misreading

3 Syncope 1- Convulsive Syncope 2- Eyes rolled back 3- Staring 4- Incontinence

4 Prodrome of Syncope  Light-headed, blurred vision, pallor, sweating, nausea…

5 Seizure Prodrome  Aura=Focal seizure Usually temporal: déjà vu Jamais vu, rising sensation in abdomen, abnormal smell or taste

6 Landmark Study of Syncope by Lempert et al, Myoclonus is common -Head turning, automatism, hallucinations

7 Postictal is the most important Syncope: No post-ictal encephalopathy low blood pressure Seizure: Amnesia, confusion, lethargy, agitation High blood pressure, tongue biting

8 EEG in convulsive syncope  Slow, then flat line  No seizure

9 Pseudo seizures  30% of referral to video monitor for “intractable seizures”

10 Combination of Seizure and Pseudo seizure is uncommon  Underlying psychopathology and emotional trauma including sexual abuse

11 Clinical signs  Stop and go activity  Out of phase  Head turning right and left  Nonclonic shaking  Pelvic thrusting  Opisthotonic posturing  Vocalization: stuttering, weeping  Preserved awareness during bilateral motor activity  Ictal eye closure  Pseudosyncope  Postictal whispering  No postictal encephalopathy

12  Another 30% patient referred for intractable epilepsy had EEG misread as epileptic

13 The most common pattern is:  Nonspecific fluctuations of background in the temporal regions

14 Epileptic discharges -clearly distinguished from background -pointed peak -spike: msec. -sharp wave: msec.

15 Maulsby’s Guidelines, Artifact until proven otherwise 2- Electrical field 3- Negative polarity 4- Followed by slow wave 5- Ignore simple alterations in voltage, or superimposed several components 6- Be familiar with “normal” sharp waves or spikes

16 Normal alpha in an adult EEG with a phase reversal at the T6 electrode derivation that was identified as “suspicious” for an epileptiform discharge (arrows)‏ with a phase reversal at the T6 electrode derivation that was identified as “suspicious” for an epileptiform discharge (arrows). Tatum W O Neurology 2013;80:S4-S11 © 2013 American Academy of Neurology

17 Normal EEG in an 18-year-old showing a hypnagogic (“drowsy”) burst (oval) of paroxysmal theta and delta frequencies that appears sharply contouredThis reflects normal electrocerebral activity during sleep transition. Note the change in the EEG immediately after the burst to reflect the change in state. The “MARK” applied by the technologist signifies a “suspicious” burst. ars sleep transition. Tatum W O Neurology 2013;80:S4-S11 © 2013 American Academy of Neurology

18 Wicket spikes appearing in repetitive bursts during the awake state in a 57-year-old (circles)‏ bursts during the awake state in a 57-year-old (circles). Tatum W O Neurology 2013;80:S4-S11 © 2013 American Academy of Neurology

19 Tatum W O Neurology 2013;80:S4-S11 © 2013 American Academy of Neurology Rhythmic midtemporal theta bursts of drowsiness in the EEG of a young adultNote the sharply contoured waveform that mimics the appearance of bilateral bursts of repetitive temporal sharp waves (boxes).

20 Figure 8 Adult EEG demonstrating lambda waves during scanning eye movements (black arrows)Although the pattern may appear morphologically as a “sharp wave,” the location, positive polarity, and the relationship to scanning eye movements (reading) are distinctive. Tatum W O Neurology 2013;80:S4-S11 © 2013 American Academy of Neurology


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