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Clinical investigations from the RACP

Assessment of patients with seizures

Chong H Wong, Andrew Bleasel

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Abstract

An accurate history is important in assessing patients presenting with seizures, and witnesses’ accounts of the event are most valuable. Few investigations provide conclusive diagnostic results, and the assessment is largely clinical.

Key Points

  • Many patients presenting for the first time with a seizure have had previous nonconvulsive seizures and have epilepsy.
  • Never assume a diagnosis of epileptic seizure without a supporting history because several nonepileptic disorders, including syncope and pseudoseizures, may mimic epileptic seizures.
  • Electroencephalography (EEG) is an important diagnostic test for patients presenting with seizures; the presence of interictal epileptiform discharges on EEG strongly supports a diagnosis of epileptic seizures.
  • Computed tomography is useful only in the acute setting when looking for structural lesions such as a stroke, abscess, haematoma or tumour.
  • Partial seizures and evidence of neurological dysfunction are predictive of seizure recurrence.

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