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4. Response; recognising the individual’s responses and following leads, respecting
information from care giver

5. Empathy; showing appropriate respect and empathy20.

Specific issues in differential diagnosis: seizures or behaviour disturbance?
In the majority of cases seizure disorder presents itself as paroxysmal episodes of abnormal
behaviour. In many cases, a generalised tonic-clonic convulsion for example, the nature of
these behaviours is well defined and does not mimic many other conditions. Other seizure
disorder, however, is less well defined or is dependent on the verbal description of the
individual and witnesses for a diagnosis. An example of the former is the pattern of behaviour
seen in complex partial seizures, particularly when there are associated ictal or post-ictal
automatisms. Differentiating these in the general population from psychiatric disturbance or,
in some cases, from non-epileptic attack disorder is complex. Differentiating these in people
with learning disability is further complicated by communication issues and the high
prevalence of behaviour and motor disorders in this population.

Repetitive episodes of manneristic or stereotyped behaviour would be most unusual in many
people without handicaps and the diagnosis of epilepsy would be highly likely. However in
a young man with autistic tendencies, for example, such behaviours may be reflections of the
cognitive disturbance of the autism and not in fact epilepsy. Clinicians need a structured
approach to this differentiation. Table 3 highlights guidelines to this differential diagnosis,
though in many cases behavioural analysis will be required to sufficiently differentiate the
behaviour.

Treatment

Unfortunately people with learning disability do not fit well into established evaluation
processes. This can be seen by a continued trend to open trials and retrospective case note
evaluations with a paucity of randomised, controlled trials, as we will discuss later.

Table 3. Differentiating seizure and behaviour disorder.

Seizure Behaviour disturbance
Identical behaviour on each occasion
Variation in behaviour with
No precipitant circumstances

Unresponsive to communication, calming Commonly precipitant such as
demands, need to avoid situation
Investigations:
Analysis of behaviour: no relationship to Responsive to calming, support,
behaviour and environment removal from stressor
Video: Shows typical seizure features
EEG: positive inter-ictal EEG Investigations:
Analysis of behaviour: relationship
found.
Video: Atypical picture seen
EEG: negative inter-ictal EEG of
some use