Summary
Definition
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
Investigations to consider
- lumbar puncture
- MRI brain
- serum prolactin
- serum creatine kinase (CK)
Treatment algorithm
≥2 unprovoked generalised tonic-clonic seizures (GTCSs) without syndromic diagnosis
≥2 unprovoked GTCSs with focal-onset epilepsy
≥2 unprovoked GTCSs with generalised-onset epilepsy
Contributors
Authors
Abdulrahman Alwaki, MD
Assistant Professor of Neurology
Emory University School of Medicine
Atlanta
GA
Disclosures
AA is a Site Principal Investigator for an EPAS (Epilepsy Post Approval Study) for deep brain stimulation funded by Medtronic and receives 1% salary support.
Daniel Winkel, MD
Assistant Professor of Neurology
Emory University School of Medicine
Atlanta
GA
Disclosures
DW receives consulting fees from NextSense, Inc.
Acknowledgements
Dr Abdulrahman Alwaki and Dr Daniel Winkel would like to gratefully acknowledge Dr Vikram R. Rao, Dr John D. Hixson, and Dr Daniel H. Lowenstein, previous contributors to this topic.
Disclosures
VRR has served as a paid consultant for NeuroPace, Inc., manufacturer of the Responsive Neurostimulation (RNS) System. VRR is also an author of several references cited in this topic. JDH has received research funding and consultancy funds from UCB Inc. DHL declares that he has no competing interests.
Peer reviewers
Edward Barry Bromfield, MD
Chief
Division of Epilepsy and Sleep
Department of Neurology
Brigham and Women's Hospital
Associate Professor of Neurology
Harvard Medical School
Boston
MA
Disclosures
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.
Roderick Duncan, MD, PhD, FRCP
Honorary Clinical Senior Lecturer
University of Glasgow
Institute of Neurological Sciences
Glasgow
UK
Disclosures
Not disclosed.
Differentials
- Psychogenic non-epileptic spells (PNES)
- Convulsive syncope
- Cardiac arrhythmia
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