Differential Diagnosis: New-Onset Seizure in the Elderly
STRUCTURAL:
• Stroke/TIA, Subdural hematoma, mass
• Traumatic Brain Injury (TBI)
- Acute Injuries: Falls leading to subdural hematomas or contusions can precipitate seizures.
- Chronic Subdural Hematomas: May present with delayed seizure onset.
METABOLIC - Electrolyte Imbalances:
• Hyponatremia
• Hypocalcemia
• Hypoglycemia
• Hyponatremia
• Hypocalcemia
• Uremia
INFECTIOUS:
• Meningitis
• Encephalitis
• Brain abscess
• Sepsis: Systemic Infections may indirectly lower seizure threshold
TOXICOLOGIC:
• Alcohol withdrawal
• Drug intoxication/withdrawal
• Medication Effects:
- Polypharmacy
- Drug interactions
NEURODEGENERATIVE:
Patients with all types of dementias are at a fivefold to tenfold increased risk of epilepsy compared to an age-matched population without dementia
• Dementia-related seizure threshold changes
• Other Dementias: May also elevate seizure susceptibility.
Seizure Mimics:
• Syncope: Transient loss of consciousness due to cardiovascular causes; may have convulsive movements.
• Transient Global Amnesia: Sudden, temporary memory loss without other neurological deficits.
• Psychogenic Nonepileptic Seizures (PNES): Behavioral events resembling seizures without EEG correlation.
• Sleep Disorders: REM behavior disorder can mimic nocturnal seizures.
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