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Diagnosis of Epilepsy: Clinical Definition, Seizure Semiology, and Differentiation from Acute Symptomatic Seizure(Provoked Seizure) Koji IIDA 1,2 1Department of Neurosurgery, Hiroshima University 2Epilepsy Center, Hiroshima University Hospital Keyword: てんかんの実用的臨床定義 , 非誘発性発作 , 急性症候性発作 , 心因性非てんかん発作 , 高齢者 , epilepsy clinical definition , unprovoked seizure , acute symptomatic seizure , psychogenic non-epilepsy seizure , PNES , elderly pp.8-16
Published Date 2023/1/10
DOI https://doi.org/10.11477/mf.1436204710
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 Recently, a practical clinical definition has been proposed by the International League Against Epilepsy(ILAE). Management of an unprovoked first seizure in adults has also been reported with risk factors of recurrence relevant to epilepsy diagnosis by the American Academy of Neurology. The term“unprovoked”implies the absence of a temporary or reversible factor lowering the threshold and producing a seizure at that point in time. A seizure immediately after a stroke or head injury would exemplify a provoked seizure, as called acute symptomatic(or early)seizure, that would not lead to a diagnosis of epilepsy. The underlying mechanisms that cause the early seizure are considered to be different from those of epileptogenesis associated with recurrent epileptic seizures. Psychogenic non-epileptic seizure(PNES)or syncope resembles epileptic seizures and are often misdiagnosed. Some clinical features can help distinguish PNES or syncope from epileptic seizure. Clinicians should be familiarized with seizure semiology presumable to epilepsy. The incidence of epilepsy increases steadily after 50 years of age. As in younger people, the diagnosis of epilepsy is a clinical decision; however, in older people this can be more challenging. Many disorders, common in older people may confuse epilepsy seizures which should be differentiated by appropriate investigations.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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