When Are Seizures and Seizure Like Events Not Epilepsy?

While any seizure is cause for concern, having a seizure does not always mean a person has epilepsy. First seizures, febrile (fever caused) seizures, non-epileptic events and seizures in pregnant women with very high blood pressure are examples of seizures that may not be associated with epilepsy.

First Seizures

Many people have a single seizure at some point in their lives. Often these seizures occur in reaction to anesthesia or a strong drug, but they also may be unprovoked, meaning that they occur without any obvious reason. Unless the person has suffered brain damage, or there is a family history of epilepsy or other abnormalities, these one-time seizures are not usually followed by additional seizures.

When someone has experienced a first seizure, the doctor will usually order an electroencephalogram, or EEG, to find out what type of seizure the person may have had and if there are any abnormalities in the person’s brain waves. The doctor also may order brain scans to identify abnormalities that may be visible in the brain. These tests may help the doctor decide whether or not to prescribe medicine to treat epilepsy. In some cases, drug treatment after the first seizure may help prevent future seizures and epilepsy. However, the drugs can also cause harmful side effects, so doctors prescribe them only when they feel the benefits outweigh the risks. Evidence shows that it may be beneficial to wait to begin medication until the person has had a second seizure, the chance of future seizures increases greatly after a second one occurs. 

Febrile Seizures

Sometimes a child will have a seizure during an illness with a high fever. These seizures are called febrile seizures (febrile is derived from the Latin word for “fever”) and can be very upsetting to the parents and other caregivers. In the past, doctors usually prescribed a course of anticonvulsant drugs following a febrile seizure in the hope of preventing epilepsy. However, most children who have a febrile seizure do not develop epilepsy, and long-term use of drugs that treat epilepsy in children may damage the developing brain or cause other harmful side effects.

Seizures Related to Eclampsia

Eclampsia is a life-threatening condition that can develop in pregnant women. Its symptoms include a sudden rise in blood pressure and seizures. Pregnant women who develop unexpected seizures should be rushed to a hospital immediately. Eclampsia can be treated in a hospital setting and usually does not result in additional seizures or epilepsy once the pregnancy is over.

Nonepileptic Events

Sometimes people appear to have seizures, even though their brains show no seizure activity. These episodes may be called nonepileptic events or pseudoseizures. Both of these terms are used to describe something that looks like a seizure but isn’t one.

Nonepileptic events can have psychological causes. These may be called psychogenic seizures. Psychogenic seizures may indicate the person has a need for attention, wants to avoid stressful situations, or has certain psychiatric conditions. Some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. Other people who have psychogenic seizures do not have epilepsy at all. Psychogenic seizures cannot be treated in the same way as epileptic seizures. Instead they are often treated by mental health specialists.

Other nonepileptic events may be caused by narcolepsy (a sleeping disorder), Tourette syndrome, cardiac arrhythmia (abnormal heart rhythm) and other medical conditions with symptoms that appear to be seizures. Because symptoms of these disorders can look like epileptic seizures, they are often mistaken for epilepsy. Telling the difference between true epileptic seizures and nonepileptic events can be very difficult and requires a thorough medical evaluation and careful monitoring by knowledgeable health professionals. 

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Epilepsy Foundation
Diagnosing Epilepsy