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Muscle stiffness, tremors, vocalization, unusual limb or head movements, disorientation, and urination are often associated with seizures, but these symptoms are not always related to epilepsy. The primary purpose of a neurological consultation for a patient with episodic behavioural disturbances is to determine the underlying cause, as different medical conditions can cause with very similar symptoms, and they are treated in different ways.

Let's consider the following situation as an example – a dog comes in for a neurological consultation, and the owner has noticed episodes of stiffness during play time or increased exertion, sometimes even causing the dog to fall over. Additionally, during these episodes, there may be occasional unintentional passing of small amounts of urine. Is this Patient history enough to diagnose epilepsy? Absolutely not! Supplementing the information from the conversation with a neurological examination becomes sufficient.

Epilepsy can be distinguished from other episodic behavioural disorders by the presence of 4 phases:

• the preictal phase,
• a short-lasting aura, which is not always visible in animal Patients,
• the ictal phase (the seizure itself),
• the postictal phase.

It is also important to note the presence of one or more symptoms from the autonomic system, such as urination, defecation, drooling, and most notably – consciousness disturbances, which are the most characteristic signs.
Between epileptic seizures, patients typically do not show any other symptoms, and their neurological examination appears normal.

Going back to the earlier example: during the conversation, it turns out that the dog has been less interested in long walks since the unusual episodes started, and during the seizures, it responds to surrounding. The neurological examination shows paraparesis, delayed correction in the hind limbs, normal spinal reflexes, and, importantly, significant pain in the lumbar area during deep palpation of the spine. In this situation, based on the information gathered from the history and neurological examination, the primary differential diagnosis should be pain attacks due to suspected changes in the lumbar spine, with epileptic seizures being considered later on.

Pain-related symptoms are often mistaken for epilepsy, which is why, before starting diagnostic tests or treatment for epilepsy, we should always rule out pain as a potential cause of the seizures through a thorough gathering of medical history and neurological examination, supplemented by imaging if necessary. A stiff gait, tripping or dragging paws during walks, reluctance to engage in physical activity or play, vocalization with sudden movements, and difficulty going up or down stairs are just a few of the symptoms an Owner might observe in their pet that is experiencing pain, veterinarian has to determine the presence of these symptoms when distinguishing painful episodes and seizures.

Another condition with episodic episodes, often mistakenly diagnosed as epilepsy, is paroxysmal dyskinesia. This term refers to episodic involuntary movement disorders of limbs, head, or entire body, without symptoms from the autonomic system. During episodes patients usually present disorientation, but do not lose consciousness and respond to their Owners. The absence of pre- and post-ictal phases is also a typical sign, which also distinguishes this disorder from epilepsy. Certain breeds are predisposed to paroxysmal dyskinesia, for example, Cavalier King Charles Spaniels can experience what's known as Episodic Falling Syndrome (EFS), Cairn Terriers and Scottish Terriers may exhibit so-called Scotty Cramp, and Border Terriers can suffer from Spike's Disease.
When diagnosing a Patient, it is worth performing a gluten sensitivity test, as this condition is often associated with the presence of antibodies against TG2 and gliadin, therefore, eliminating gluten from the diet often leads to the resolution of symptoms.

It should also be borne in mind that seizures do not always have a dramatic course accompanied by tonic-clonic convulsions, defecation, urination and drooling. For example, some feline patients may present so-called Temporal Lobe Epilepsy, where the most common symptoms include mewling, drooling, facial muscle tics, excessive licking, chewing, or swallowing.

The basis for a final diagnosis of epilepsy is ruling out all other conditions causing similar symptoms. Recording episodes of occurring disorders at home enables a faster diagnosis, while the easy access to information from sources like literature and the internet is a great help for both practicing veterinarians and pet owners.