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Epilepsy - Making a diagnosis
When should I suspect it?
- Suspect an epileptic seizure when there is a brief attack of [Elger and Schmidt, 2008]:
- Altered consciousness.
- Motor, sensory, autonomic, or cognitive disturbance.
- When an epileptic seizure is suspected assess for:
- Clinical features of different seizure types.
- Risk factors for epileptic seizures.
- Other causes for epileptic seizures, that are not of a primary cerebral origin (that is, due to a transient identifiable cause such as hypoxia).
- Other conditions causing similar symptoms.
- The assessment should include [NHS Newcastle et al, 2008]:
- A detailed description of the attack from the person, and ideally also from a first-hand witness.
- A systems review, examination, and investigations to identify possible causes for epileptic seizures and exclude other causes for the symptoms.
- In adults, primary care investigations should include an electrocardiograph (ECG), full blood count, urea and electrolytes, liver function tests, glucose, and calcium.
- In children, investigations should be at the discretion of a specialist.
- Suspect epilepsy when:
- There is a convincing history of an epileptic seizure, and
- Epileptic seizures that are not of primary cerebral origin have been excluded (for example, alcohol-withdrawal seizure).
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