Conditions That Look Like Seizures but Are Not

Not every event that “looks like a seizure” is an epileptic seizure. There are many conditions in children that can be confused with epilepsy. Making this distinction is important, because their treatment is completely different from that of epilepsy. The table below summarizes the most commonly confused conditions and their distinguishing features. This table is not a diagnostic tool; it is only for awareness. If you are in doubt, consult your physician.

• Condition
• Typical Features
• Difference from Epilepsy
• Fainting (syncope)

While standing, in the heat, or at the sight of blood; preceded by dimming vision and sweating

• Short-lived, quick recovery, clear trigger
• Breath-holding spell
• Holding the breath after crying, turning blue/pale, brief fainting
• There is always a trigger (crying, anger, pain)
• Night terror
• Sudden screaming and fear in the first hours of sleep, but without fully waking
• Related to sleep, not remembered in the morning, EEG normal
• Tics
• Repetitive eye blinking, shoulder shrugging; can be suppressed for a short time
• No loss of consciousness, can be voluntarily stopped for a short time
• Migraine / aura
• Headache, visual symptoms, nausea
• Develops more slowly, consciousness is usually preserved
• Shuddering attack
• Sudden stiffening and trembling in a young child (with fever/excitement)
• Brief, benign, does not affect development
• Psychologically based event
• Related to stress, variable, atypical movements
• There is no epileptic change on EEG; a different kind of support is needed

Video changes everything

The most powerful way to tell these conditions apart from epilepsy is to record the event on video.

If a suspicious event occurs, record it once you have made sure it is safe to do so, and show it to your physician. If necessary, video-EEG monitoring provides a definitive distinction (see Chapter 18).