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Clinical investigations from the RACP

Investigating a seizure: is it epilepsy?

Armin Mohamed

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Abstract

Epileptic seizures have varied symptoms and many paroxysmal events can be imitators of epileptic attacks. A detailed eyewitness report of the patient’s behaviour during a seizure can be a valuable diagnostic tool.

Key Points

  • A detailed eyewitness report of the patient’s behaviour during a seizure can be a valuable ‘diagnostic tool’. The best chance of obtaining this is when the patient presents.
  • EEG remains the best diagnostic test for epilepsy but has a low yield unless prolonged studies are performed.
  • Structural brain imaging abnormalities may be found on MRI in almost half of adults and up to one-third of children who present with a first seizure.
  • Metabolic derangement is the aetiology for a seizure in only a small proportion of patients.

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