Clinical Assessment of Patient with Epilepsy

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History

A detailed clinical history is crucial to accurate diagnosis and should be obtained from the child (when possible) as well as directly from the person who witnessed the event. Children as young as 3 years of age can provide very useful information regarding both aura and postictal phase.

The provider should obtain a complete description of the event from beginning to end, including details of the seizure itself, any potential preceding aura, and the postictal period, including witnessed postictal focal deficits. In addition to obtaining a careful verbal description of seizures, it is often helpful for the witness to “mime” the event. With a detailed history, the provider can often identify whether the spell(s) in question represents a seizure versus another paroxysmal event (Table 1).

The medical history should include maternal pregnancy history, delivery history (including birthweight, Apgar scores, need for resuscitation), and neonatal course. Developmental history should evaluate gross motor, fine motor, speech/language, and social domains, assessing for evidence of developmental delay, plateau, or regression.

Because many types of epilepsy have a genetic basis, a detailed family history is recommended. Sometimes, these details may not be known at the initial assessment but can be obtained at later visits.In addition, as noted previously herein, the so-called first seizure may just be the first witnessed or identified seizure. (10) Families should be questioned about more subtle symptoms of seizures, including early morning jerks, episodes of “zoning out,” nocturnal arousals, and bed-wetting.

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