Audia • Aurora Glass Neural
Seizure Types, Mimics & EEG Patterns
Not all seizures are epileptic.
Many mimics are treatable once correctly identified (e.g., PNES, metabolic, functional).
EEG is critical, but a normal EEG doesn’t always rule out epilepsy.
Multidisciplinary evaluation is often necessary: neurology, psychiatry, immunology, sleep medicine, genetics.
I. True Epileptic Seizures (EEG-Confirmed)
Involve abnormal cortical discharges.
A. Focal Seizures
- Focal aware (simple partial)
- Focal impaired awareness (complex partial)
- Focal to bilateral tonic-clonic
B. Generalized Seizures
- Absence (petit mal)
- Tonic
- Clonic
- Tonic-clonic (grand mal)
- Atonic (drop attacks)
- Myoclonic
C. Epileptic Syndromes
- Juvenile Myoclonic Epilepsy (JME)
- Lennox-Gastaut Syndrome (LGS)
- Childhood Absence Epilepsy
- West Syndrome (infantile spasms)
- Dravet Syndrome
- Doose Syndrome (myoclonic-atonic epilepsy)
D. Reflex Epilepsies
- Photosensitive
- Musicogenic
- Reading epilepsy
- Hot-water epilepsy
E. Status Epilepticus
- Convulsive
- Non-convulsive (NCSE)
II. Epileptic Encephalopathies & Syndromes
Genetic & Developmental
- Dravet Syndrome (SCN1A, febrile/myoclonic)
- Ohtahara Syndrome (tonic spasms, burst suppression)
- Early Myoclonic Encephalopathy (metabolic/genetic origin)
- West Syndrome (hypsarrhythmia + spasms)
- Lennox-Gastaut Syndrome (mixed, cognitive decline)
- Doose Syndrome (myoclonic-atonic)
Genetic Syndromes (Childhood–Adolescence)
- Benign Rolandic Epilepsy / BECTS
- Panayiotopoulos Syndrome (autonomic, occipital EEG spikes)
- Childhood Absence Epilepsy (3Hz spike-wave)
- Juvenile Myoclonic Epilepsy
- Jeavons Syndrome (eyelid myoclonia + photosensitivity)
Focal Structural Epilepsy Syndromes
- Temporal Lobe Epilepsy (auras, automatisms)
- Frontal Lobe Epilepsy (nocturnal, bizarre)
- Occipital Lobe Epilepsy (visual)
- Parietal Lobe Epilepsy (somatosensory)
III. Progressive Epilepsy Disorders
- Rasmussen’s Encephalitis (immune-mediated hemiparesis)
- Lafora Disease (adolescent fatal PME)
- Unverricht–Lundborg (less severe PME)
- Batten Disease (CLN/NCLs) (seizures, regression)
IV. Autoimmune & Metabolic Epilepsy
- Autoimmune Epilepsy (Anti-NMDA, GAD65, VGKC, etc.)
- FIRES (Febrile Infection-Related Epilepsy Syndrome)
- Glut1 Deficiency Syndrome (low CSF glucose; keto diet effective)
- MERRF (Mitochondrial epilepsy)
- Alpers-Huttenlocher Syndrome (POLG mutation)
🚫 V. Non-Epileptic Events (EEG-Normal)
A. Psychogenic Non-Epileptic Seizures (PNES)
- Dissociative, trauma-linked
- Video EEG is diagnostic
B. Medical Mimics
| Condition | Notes |
|---|---|
| Syncope | Jerking may occur during brief cerebral hypoxia |
| Hypoglycemia | Tremor, collapse |
| Hypoxia/Anoxia | Post-anoxic myoclonus |
| Electrolyte imbalance | Confusion, jerks |
| Toxic encephalopathy | Baclofen, lithium, serotonin syndrome |
| Narcolepsy/Cataplexy | Sudden atonia with emotion |
| Breath-holding spells | Seen in toddlers |
| Hyperventilation | Tingling, tremor, dizziness |
C. Encephalopathies
| Type | Features |
|---|---|
| Metabolic | Uremia, hepatic, diabetic |
| Infectious | HSV, West Nile, etc. |
| Autoimmune Encephalitis | Anti-NMDA, GAD65, VGKC |
| Cortical Spreading Depression (CSD) | Migraine aura; transient EEG suppression |
🧍 VI. Movement Disorders Mimicking Seizures
Motor events without EEG seizure activity.
A. Hyperkinetic Movement Disorders
| Disorder | Features |
|---|---|
| Tics | Repetitive, suppressible (Tourette) |
| Stereotypies | Rhythmic, purposeless (autism, IDD) |
| Myoclonus (non-epileptic) | Sleep, metabolic, post-anoxic |
| Chorea | Irregular, dance-like |
| Ballismus | Violent flinging |
| Dystonia | Sustained, twisting postures |
| Athetosis | Writhing movements |
| Tremor | Essential, parkinsonian, drug-induced |
| Startle syndromes | Hyperekplexia, exaggerated reflexes |
B. Paroxysmal Dyskinesias
| Type | Trigger |
|---|---|
| PKD | Sudden motion |
| PNKD | Spontaneous, stress, caffeine |
| PED | After exertion |
💤 VII. Sleep-Related Events
Look seizure-like but occur in transitions between sleep stages.
| Disorder | Notes |
|---|---|
| Night terrors | Screaming, no recall |
| REM Behavior Disorder (RBD) | Acting out dreams |
| Sleepwalking | Complex behavior, no memory |
| Rhythmic Movement Disorder | Head-banging, body-rocking |
🌀 VIII. Other Paroxysmal or Psychiatric Events
Not epileptic, but episodic or seizure-like in appearance.
| Condition | Features |
|---|---|
| Autonomic Seizures | Panayiotopoulos: vomiting, eye deviation |
| Febrile Seizures | Age 6mo–5yr; triggered by fever |
| Vestibular Disorders | Vertigo, imbalance, mimic drop attacks |
| Migraine Variants | Aura, hemiplegia, basilar |
| PANDAS/PANS | Tics, rage, regression post-infection |
| Functional Movement Disorders | Inconsistent, distractible patterns |
| Narcolepsy/Cataplexy | Sleep-attacks, emotional atonia |
🧾 IX. EEG Patterns: Interpretation Guide
| EEG Finding | Meaning |
|---|---|
| Epileptiform discharges | Spike/sharp waves = epilepsy |
| Generalized slowing | Metabolic/toxic encephalopathy |
| Focal slowing | Structural lesion |
| Normal EEG | Doesn’t exclude epilepsy (esp. PNES, subclinical) |
| Hypsarrhythmia | West Syndrome (chaotic infantile spasms) |