Is it Epilepsy or Something Else?

Several conditions can mimic epilepsy. Seizures are one of the most visible symptoms of epilepsy. But not everyone who has a seizure has epilepsy. Many other conditions can also cause seizures or unusual body movements.¹

What is a seizure?

Seizures are temporary events that occur due to abnormal electrical activity in the brain. Seizures are classified by the different physical ways in which the body is affected. People with epilepsy have seizures that fall into 3 general categories:^2,3

• Focal onset seizures – These start in 1 area or on 1 side of the brain. The person may be alert and aware, or they may be confused and have some level of affected awareness. Also called simple partial seizures.
• General onset seizures – Affect both sides of the brain at the same time.
• Unknown onset seizures – It is not clear where these seizures start. Doctors may be able to later pinpoint an origin when they have more information.

If you suspect seizures in a loved one, take videos of their unusual movements. This could be helpful for your doctor in diagnosing the condition.¹

Often confused with epilepsy

A few different conditions have seizures or seizure-like movements as a symptom. These can be grouped into a few broad categories.^1,4-8

Movement imitators

Several conditions can cause unusual posture, verbal outbursts, or simple partial seizures. These include physical tics, jitteriness, and Tourette’s syndrome. The unusual movements caused by these conditions are sometimes confused with epilepsy, but they are different.^1,6,8

Loss of consciousness imitators

Losing consciousness can sometimes be mistaken for a seizure. Fainting is the most common reason why a person loses consciousness. While there are many causes of fainting, they are different from a seizure. Fainting is caused when the brain lacks enough blood to properly function. Sometimes, fainting itself can trigger a seizure.^1,5,6

Confusion imitators

Several different conditions can cause people to suddenly become confused. One of the most common is a transient ischemic attack (TIA or mini-stroke). This is caused by a brief interruption of blood flow to the brain. Altered speech and sudden confusion can follow. Migraine can also cause confusion in some people and be mistaken for epilepsy.^1,6

Psychological imitators

Two common conditions in this category are hyperventilation and panic attacks. Hyperventilation occurs when someone breathes too hard and fast. Panic attacks are episodes of deep and distressing fear that cause physical reactions.^1,5,6,9

Non-epileptic seizures (NES)

This refers to seizure-like episodes that happen but are not due to abnormal electrical activity in the brain. A non-epileptic seizure (NES) is usually brought on by psychological conditions. It can be very difficult for a doctor to distinguish between an NES and an epileptic seizure.^1,4,5

Other overlaps with epilepsy symptoms

Other conditions that might mimic epilepsy include daydreaming, breath-holding, and sleep disorders.

Daydreaming

Some children are daydreamers. Absorbed in their fantasy, they may stare off into space. While staring can occur during an alert seizure, if the child lacks other symptoms then they are likely just enjoying a fantasy. Other true seizure symptoms may be lip-smacking, eye blinking, or stiffened muscles. Context can also offer clues. Children enjoying an activity are not likely to suddenly stare blankly. However, a child who is calm or bored may do just that.⁸

Breath-holding

Young children caught up in a tantrum may hold their breath until they turn blue. The lack of oxygen that follows can cause fainting, but this is not due to a seizure.⁸

Sleep disorders

People who have sleep disorders may sometimes be mistaken for having a seizure. But while people can usually be woken from slumber, someone having an epileptic seizure can not. The following sleep disorders may produce movements that mimic epilepsy:^1,6

• Benign neonatal myoclonus, where infants may harmlessly shake during sleep
• Sleep-related rhythmic movement disorders, where babies exhibit body-rocking, rolling, and headbanging
• Hypnic jerks, where children and adults jerk and twitch in their sleep, sometimes enough to wake
• Parasomnias, where sleep-walking and confused states occur when a person is deeply asleep
• Narcolepsy, where sleep-wake boundaries become indistinct

How to tell the difference

Some conditions are very difficult to tell apart from epilepsy. Some non-epileptic conditions can also co-exist with epileptic ones, making it even harder.

Only a doctor can diagnose epilepsy. However, you can help by making video recordings of the unusual body movements to show your doctor. Writing down details about seizure-like events might also be helpful in getting the right diagnosis.⁴