Seizure Mimics in Children & Adults: Which events can be mistaken for seizures?

Can non-seizure events in adults be mistaken for Seizures?


Some events look almost precisely like seizures but are not seizures. These events are called “Seizure Mimics”, and may be mistaken for seizures.

Seizure mimics look like seizures, but are NOT seizures.

There is NO electrical surge in the brain with any of these “Seizure Mimics”.

This is an easy error to make, even for doctors. Whenever a patient loses consciousness, one of the first things that we think of is a seizure!

While this is a good approach, it is crucial to confirm the diagnosis. If an event is mistaken for a seizure, two things happen: Unnecessary treatment with anti-epileptics, and lack of treatment for the “true” condition (e.g. cardiac arrhythmia).

Only seizure mimics that happen in both adults and children are described in this article.

For getting the complete picture in children, please also read the other article: [Seizure mimics in children]

Which are the 6 most important “Seizure Mimics” in Adults & Children?

Here they are!

Seizure Mimic


Decreased blood supply to the brain = Syncope (Most important!) – Heart problems

– Overactivity of the vagal nerve

– A sudden drop in BP on standing up

– Problems with blood vessels going to the brain

Sleep Abnormalities
A structural problem in the brain– Colloid cyst

– Chiari malformation

– Multiple Sclerosis

“Movement Disorder”– Paroxysmal Dyskinesias

– Lance-Adams syndrome

Psychogenic Non-Epileptic Seizures (PNES)

What is “Syncope”?

“Syncope” is the most important and common Seizure Mimic.

“Syncope” means loss of consciousness due to decreased blood supply to the brain.

Syncope is caused by lack of blood supply to the brain.

The causes and treatment of syncope are described in more detail in another article here: [What is syncope?]

Who gets hypoglycemia?

Hypoglycemia means “Low Blood Glucose”. Medications frequently cause severe hypoglycemia.

If you have diabetes and take too much insulin, your blood sugar can become very low. This is dangerous and may cause you to lose consciousness.

Low blood sugar levels can cause you to pass out.

Taking too much insulin is the most common reason for severe hypoglycemia. However, a few other conditions may also cause severely low blood glucose:

  • Certain combinations of medications: E.g. Metformin can have an increased effect & cause severe hypoglycemia if given with some antifungals, antibiotics or antacids.
  • A direct side-effect of some medications: e.g. cotrimoxazole, Quinidine, MAO-inhibitors given for Parkinson’s etc.
  • Alcoholism
  • Very rarely, there may be a minute tumour in the intestines that produces insulin. This is called an “Insulinoma”.
Very rarely, a small tumor in the intestines called an INSULINOMA may be responsible for low blood sugar levels.

There are two other, rare causes:

  • Uncommonly, other endocrine problems such as: Low pituitary, adrenal, or thyroid functioning can also cause episodes of hypoglycemia.
  • Uncommonly, problems with glucose handling in the liver such as due to alcoholic cirrhosis or some inborn errors of metabolism may cause such episodes.

Usually, there are some warning signs before the patient loses consciousness. 30 minutes to an hour before losing consciousness, you may start getting irritable and have difficulty thinking. You may have sweating & start trembling. Your vision may become blurred, and you may find it difficult to move. Gradually you get more and more confused and ultimately may lose consciousness. In severe cases, you may even get an actual seizure.

Anxiety and panic can cause seizure-like attacks. These are called Non-Epileptic attacks.

Checking your blood sugar multiple times (for example every 2 hours & especially when you get the warning symptoms) for a full day gives you the diagnosis.

Treatment is based on the cause. A simple reduction in the dose of insulin or adjustment of medications resolves most cases. If you have an insulinoma, removing it stops these episodes.

Which sleep abnormalities can resemble seizures?

Multiple sleep problems may produce symptoms like a Seizure. We can briefly talk about each one of these:

Sleep Problems Mimicking SeizuresWhat happens?
Confusional ArousalsThe child suddenly wakes up confused and disoriented
Sleep TerrorsThe child wakes up screaming & crying and is difficult to console
REM Behavior Disorder (RBD)The person acts out his/her dreams. Can occur by itself or as part of Parkinsonism [Details here]
NightmaresBad, bad dreams that wake you up, and are remembered
NarcolepsyThe child can abruptly nod off to sleep & may drop down to the ground
Hypnagogic & Hypnopompic HallucinationsVisual hallucinations can happen as the patient is sleeping (-gogic) or when the patient is waking up (-pompic)
Night terrors may be confused with seizures. A sleep study is needed in such cases.

Seizures starting from the Frontal lobe can happen only while sleeping and may be mistaken for one of these events. Therefore, in almost all these cases, a video-EEG is essential to rule out Seizures. 

Medications are helpful. Sedatives help in all cases, but other things such as avoiding stimulants before going to bed & Melatonin may be useful in carefully chosen patients.

Which structural problems in the brain may cause episodes of loss of consciousness?

Structural problems in the brain (such as old scars or tumours) frequently produce seizures. Very rarely, they can cause events that look like seizures but are not seizures.

These situations are so rare that I think it’s reasonable to discuss only two of them here:

  • A Colloid Cyst: A “Colloid Cyst” in the brain looks like a jelly-filled ping-pong ball, attached to the inner surface by only a thin thread. Because it is so mobile, it can bounce around on the inside of the brain.
    Occasionally, when the head position is changed, the colloid cyst abruptly blocks the flow of fluid in the brain. When this happens, you can suddenly lose consciousness for a few seconds, only to regain it again when the colloid cyst bounces away.
  • Chiari Malformation: A Chiari Malformation is a condition in which the back of your brain descends downward. When you cough or strain at stool, this hanging part of the brain is pushed even lower. Because this causes crowding and compression of these parts, you may suddenly lose consciousness.

Both these conditions are very quickly diagnosed, both by their typical history and by a quick MRI.

Which disorders of Movement may be mistaken for Seizures?

These are very rare and have only been recently described.

These are called Paroxysmal Dyskinesias. There are two types: Either precipitated by Movement (Kinesigenic) or happening at random (Non-Kinesigenic).

Since these are rare, I’m not describing them here. Please let me know if I should.

What are Psychogenic Non-Epileptic Seizures (PNES)?

Psychogenic Non-Epileptic Seizures are not produced by a surge of electricity. It is less confusing to refer to them as Psychogenic Non-Epileptic Shaking, which is what I will stick to from here on.

This entity is mentioned at the very end because it is essential to rule out ALL the other problems mentioned above, before making the diagnosis of PNES.

Excessive stress can cause seizure-like attacks. These are called Non-Epileptic attacks.

This is a real, distressing condition produced by an imbalance in the systems of the Mind. Thankfully, proper recognition of these events, competent & interested doctors, and appropriate treatment can end these shaking events.

Read the complete article on PNES here: [What are psychogenic seizures / PNES?]





Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ a year ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ a year ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ a year ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ a year ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ a year ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

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