Last reviewed: 8 Feb 2021
Last updated: 18 Oct 2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • focal neurological deficits
  • focal neurological symptoms (before or after seizure)
  • premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu)
  • temporary hemiparesis
  • temporary aphasia
  • fever, nuchal rigidity, altered mental status

Other diagnostic factors

  • neurocutaneous findings of neurological disease

Risk factors

  • family history (extended or immediate) of generalised-onset epilepsy
  • previous central nervous system (CNS) infection
  • head trauma
  • prior seizure events or suspected seizure events
  • history of substance use
  • premature birth
  • multiple or complicated febrile seizures

Diagnostic investigations

1st investigations to order

  • electroencephalogram (EEG)
  • blood glucose
  • FBC
  • electrolyte panel
  • toxicology screen
  • head CT
  • serum prolactin
  • serum creatine kinase (CK)

Treatment algorithm


Assistant Professor

Clinical Neurology

University of California, San Francisco

San Francisco



VRR is an author of a number of references cited in this monograph. He served as a paid consultant for NeuroPace, Inc., manufacturer of the Responsive Neurostimulation (RNS) System.

Associate Professor

Clinical Neurology

University of California, San Francisco

San Francisco



JDH has received research funding and consultancy funds from UCB Inc.

Dr Vikram R. Rao and Dr John D. Hixson would like to gratefully acknowledge Dr Daniel H. Lowenstein, a previous contributor to this topic. DHL declares that he has no competing interests.

Peer reviewersVIEW ALL


Division of Epilepsy and Sleep

Department of Neurology

Brigham and Women's Hospital

Associate Professor of Neurology

Harvard Medical School




EBB has received speaking fees from ICR Pharma, Novartis, Abbott Laboratories, GlaxoSmithKline, and Pfizer. He has received consulting fees from ICR Pharma, Genzyme, and Spherics, and research funding from UCB Pharma. Unfortunately we have since been made aware that EBB is deceased.

Honorary Clinical Senior Lecturer

University of Glasgow

Institute of Neurological Sciences




Not disclosed.

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