Editing Seizure (section)

==Clinical evaluation==

The clinical evaluation after a seizure event involves confirming if the episode was epileptic in nature, determining its type and cause, and distinguishing it from other conditions that can mimic seizures. A careful clinical history and targeted investigations are essential.<ref name="Berkowitz2022" /><ref name="Abou-Khalil2022" />
The antecedent events preceding seizure onset, as well as the clinical signs observed during the episode, are critical for accurately classifying the seizure type. However, because most individuals do not recall the details of their own seizures, obtaining eyewitness accounts is often essential for an accurate diagnosis.<ref name="Berkowitz2022" /><ref name="Abou-Khalil2022" /><ref name="Rowland2022">{{Cite journal |last1=Rowland |first1=Kate |last2=Lambert |first2=Carl Earl |date=2022-05-01 |title=Evaluation After a First Seizure in Adults |url=https://pubmed.ncbi.nlm.nih.gov/35559631 |journal=American Family Physician |volume=105 |issue=5 |pages=507–513 |issn=1532-0650 |pmid=35559631}}</ref> Video recordings, when available, provide valuable supplementary information, particularly in distinguishing epileptic seizures from mimics such as psychogenic nonepileptic seizures.<ref name="Abou-Khalil2022" />

The clinical history should include:

* Preictal symptoms (auras), such as unusual sensations, déjà vu, or fear
* Ictal features, including motor activity, awareness, automatisms, or autonomic signs
* Postictal symptoms, such as confusion, drowsiness, focal weakness (Todd’s paralysis), or headache

Medical history is also important, including:

* Previous neurological insults (e.g., traumatic brain injury, stroke, central nervous system infections)
* Developmental history in children
* Family history of epilepsy
* History of febrile seizures
* Use of medications, alcohol, or illicit substances

[[File:Bittentongue.JPG|thumb|An individual who has bitten the tip of their tongue while having a seizure]]

=== Physical examination ===
A focused neurological examination can yield additional diagnostic clues, particularly soon after a seizure. Findings may include:<ref name="Abou-Khalil2022" />

* Tongue or oral injuries, such as lateral tongue bites, which strongly suggest a generalized tonic–clonic seizure, though they occur in only about one-third of cases
* Postictal focal neurological signs, such as weakness or asymmetric reflexes
* Urinary or fecal incontinence, which, while not specific, can support the diagnosis of a generalized seizure

Between seizures, the neurological examination is often normal.<ref name="Abou-Khalil2022" />

=== Laboratory tests ===
Laboratory testing is often performed in the evaluation of a new-onset seizure, particularly when a provoked cause is suspected.<ref name="Berkowitz2022" /> Common investigations include:

* Serum glucose: to rule out hypoglycemia
* Electrolytes (sodium, calcium, magnesium): to identify metabolic disturbances<ref name="Winkel2022">{{Cite book |last1=Winkel |first1=Daniel |title=Bradley and Daroff's Neurology in Clinical Practice |last2=Cassimatis |first2=Dimitri |publisher=Elsevier |year=2022 |isbn=978-0323642613 |edition=8th |pages=8–16 |chapter=Episodic Impairment of Consciousness |chapter-url=https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323642613000024}}</ref>
* Renal and hepatic function panels: to assess for systemic dysfunction
* Toxicology screening: to detect alcohol, illicit substances, or prescription drug toxicity
* Infection markers (e.g., complete blood count, inflammatory markers): when infection is suspected

Laboratory findings can help identify treatable causes of seizures and guide management decisions.[[File:EEG Recording Cap.jpg|thumb|An EEG can aid in locating the focus of the epileptic seizure.|245x245px]]

=== Electroencephalography (EEG) ===
An '''electroencephalogram (EEG)''' records electrical activity in the brain and can help support a diagnosis of epilepsy.Interictal EEG may reveal epileptiform abnormalities, such as spikes, sharp waves, or spike-and-wave discharges. However, a normal EEG does not exclude epilepsy.

In certain cases, prolonged video EEG monitoring is used to capture seizures in real time and clarify seizure type, localization, or the diagnosis when psychogenic nonepileptic seizures are suspected.

=== Neuroimaging ===
Brain imaging is recommended in most cases of new-onset unprovoked seizures to identify structural abnormalities that may predispose to epilepsy. Imaging techniques include:<ref name="Abou-Khalil2022" />

* Magnetic resonance imaging (MRI): the preferred modality for detecting cortical dysplasia, tumors, mesial temporal sclerosis, and other lesions
* Computed tomography (CT): often used in emergency settings to exclude acute hemorrhage or trauma

===Differential diagnosis===
Several conditions can mimic epileptic seizures and must be considered:

* Syncope (transient loss of consciousness due to cerebral hypoperfusion)
* Psychogenic nonepileptic seizures (PNES)
* Transient ischemic attacks (TIAs)
* Paroxysmal movement disorders
* Migraine aura

Differentiating these conditions from epileptic seizures relies on careful history-taking, examination, EEG findings, and, when necessary, additional cardiac, metabolic, or psychiatric evaluations.