Epilepsy
- Presentation

Features to note on history (regarding the attack)

• Preceding aura
• Abrupt or gradual onset
• Progression of motor activity
• Loss of bowel or bladder control
• Activity ?generalised ?symmetrical
• Duration
• Any post-ictal confusion or lethargy
• Any recollection of the attack

 

Features to note on other history

• History of epilepsy, usual pattern
• Change in medication
• Compliance with medication
• Other precipitating factors:
     * Sleep deprivation
     * Alcohol withdrawal
     * Infection
     * Use or cessation of drug/medications
• History of head injury
• Unexplained injuries
• Headache

 

Features to note on physical examination

• Look for and exclude signs of raised intracranial pressure
• May see Todd's paralysis following a simple or complex focal seizure
  -> Todd's paralysis: transient, focal neurological deficits, occurring after a seizure, that resemble a stroke but resolve spontaneously within 48 hours.
• Do neurological examination
• Note any injury that may cause or be caused by the seizure

 

Features that distinguish seizures from other attacks

• Abrupt onset and termination
     * Most seizure last 1-2 minutes
     * Focal seizures can be preceded by auras that last >20 seconds
• Lack of recall, except for simple partial seizures
• Movements or behaviour during the attack generally are purposeless or inappropriate
• Most seizures, except for absence seizures or simple partial seizures, are followed by a period of post-ictal confusion and lethargy