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  • Updated 03.22.2024
  • Released 08.15.2014
  • Expires For CME 03.22.2027

Ambiguous paroxysmal events

Initial evaluation

The initial diagnosis of seizure is based on the history. If first-line treatment fails, the diagnosis is (or should be) questioned and verified. At epilepsy centers, where selected challenging patients are seen, the evaluation typically begins with video-EEG monitoring, which allows a clear diagnosis in the vast majority of cases (10; 08). Typically, video-EEG will answer the following questions:

(1) Is it epilepsy or not?
(2) If it is not epilepsy, what is it?
(3) If it is epilepsy, what type?
(4) If seizures are focal, where is the focus?

In this article, we will focus on the first two questions. Is it epilepsy or not? If it is not epilepsy, what is it? In the vast majority of cases, the question of “epilepsy or not” is easily answered, so we will focus on the relatively small proportion of situations in which, despite good EEG or video-EEG recordings, the question remains difficult to answer. We will divide “ambiguous” events into clinical and electrographic events.

Cell phone videos can be particularly helpful at clarifying ambiguous events, and studies have shown excellent diagnostic value (27; 02).

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