(p. 81) Differential Diagnosis of Epilepsy 

Paroxysmal attacks with or without loss of consciousness are common in both children and adults. The correct treatment depends on the cause of the attacks, so the consequences of misdiagnosis may be far-reaching. Taking a good history (including a witness report) is as crucial in the diagnostic process as it is important to have a good knowledge of the range of possible presentations of different paroxysmal events. Diagnostically relevant information is not limited to the symptoms and signs during the onset, course and offset of the attack, but includes information on the circumstances, past medical history and family history as well as how patients interact with their doctor. Factual information clusters are of greater diagnostic value than interictal investigations. A ‘gold standard’ diagnosis involves the observation of attacks during simultaneous recording of video, EEG and ECG, but is often not achievable. This chapter discusses the diagnostic process of adults and children presenting with paroxysmal neurological disorders in general and transient loss of consciousness (TLOC) in particular. It describes the typical features of syncope, episodic psychiatric, sleep and movement disorders, transient ischaemic attacks, migraine, transient global amnesia, metabolic disorders and differential diagnoses only encountered in paediatric practice. The chapter focuses on the clinical presentations, diagnostic difficulties and potential clues.