Last reviewed: 25 Oct 2020
Last updated: 06 Jun 2018



History and exam

Key diagnostic factors

  • movement of one side of the body or one specific body part
  • premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu)
  • automatisms (picking at clothes, smacking of the lips)
  • temporary aphasia
  • staring and loss of contact with the environment

Other diagnostic factors

  • postictal focal neurological deficit (Todd paralysis, aphasia)
  • persistent focal neurological deficit
  • poor memory
  • stigmata of neurocutaneous syndromes

Risk factors

  • febrile seizure
  • head trauma
  • CNS infection
  • stroke
  • brain tumor
  • mental retardation (MR) and/or cerebral palsy
  • dementia
  • FHx of seizures
  • vascular malformations
  • male

Diagnostic investigations

1st investigations to order

  • blood glucose
  • CBC
  • electrolyte panel
  • toxicology screen
  • lumbar puncture and CSF analysis
  • CT head
  • MRI brain
  • EEG
More 1st investigations to order

Investigations to consider

  • serum prolactin
  • video/EEG long-term monitoring (LTM)
  • PET scan
  • single photon emission computed tomography (SPECT) scan
  • functional MRI scan
  • magnetoencephalography (MEG scan)
  • neuropsychological testing
  • Wada test
More investigations to consider

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 Jeffrey Cohen, a previous contributor to this monograph. JC declares that he has no competing interests.

Peer reviewersVIEW ALL


Epilepsy Division

Brigham and Women's Hospital

Associate Professor of Neurology

Harvard Medical School




At the time of review, EB declared that between 2004 and 2009, he received speaking honoraria from UCB Pharma, Novartis, Abbott Laboratories, GlaxoSmithKline, and Pfizer. He received consulting fees from UCB Pharma, Genzyme, and Spherics, and research funding from UCB Pharma. Unfortunately, we have since been made aware that EB is deceased.

Associate Professor

Pediatrics and Neurology

Baylor College of Medicine

Medical Director

Comprehensive Epilepsy Program

Texas Children's Hospital




AAW declares that he has no competing interests.

Assistant Professor

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York



Not disclosed.

Consultant Neurologist

Muscular and Neurodegenerative Diseases Unit

"G Gaslini" Institute


Epilepsy Centre

Federico II University




PS declares that he has no competing interests.

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