Paroxysmal states are sudden, short-term, and reversible disorders of nervous system function. In this chapter, we analyze the two most common causes of such episodes: epilepsy and fainting (syncope). The ability to quickly distinguish an epileptic seizure from a non-epileptic one is a basic skill for a physician of any specialty.
The section includes three key topics: clinical presentation and diagnosis of epilepsy, emergency care algorithms for status epilepticus (a condition that directly threatens the patient's life), and differential diagnosis of syncope. We rely on modern international classifications and current treatment protocols.
In classes and exams, traditionally the greatest attention is paid to the criteria for diagnosing epilepsy, the principles of choosing first-line antiepileptic therapy, and the step-by-step algorithm for arresting status epilepticus. In addition, be prepared to perform a clinical differential diagnosis between convulsive syncope and a true epileptic seizure—this is a favorite question of instructors.