Questionnaire/history:

Predisposition for epilepsy?

- Premature birth?

- Complicated febrile seizures?

- Genetic condition (eg tuberous sclerosis, neurofibromatosis)?

- Brain development malformations?

- Family history of epilepsy?

- Neurological illness?

- Head trauma?

- Infections (eg meningitis, encephalitis)?

- Tumours?

- Comorbidities (eg cerebrovascular disease, stroke)?

- Dementia?

- Neurodegenerative disorders (people with Alzheimer's disease)?

What happened before, during and after the attack (from the patient and an eyewitness)?

Any subjective symptoms at the start of the seizure (aura)?

Any potential triggers?

- Sleep deprivation?

- Stress?

- Light sensitivity?

- Alcohol use?

Specific features of the seizure?

- Short-lived (less than 1 minute), abrupt generalised muscle stiffening (may cause a fall) with rapid recovery (suggestive of tonic seizure)?

- Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting (indicative of generalised tonic-clonic seizure)? - Behavioural arrest (indicative of absence seizure)? - Sudden onset of loss of muscle tone (suggestive of atonic seizure)?

- Brief, 'shock-like' involuntary single or multiple jerks (suggestive of myoclonic

seizure)?

Residual symptoms after the attack (post-ictal phenomena)?

- Drowsiness?

- Headaches?

- Amnesia?

- Confusion?

(Note: Residual symptoms usually occur only after generalised tonic and/or clonic seizures.)

Past medical history?

Family history?

Current medication?

Examination:

Cardiac?

Neurological?

Mental health?

Oral mucosa (eg lateral tongue bites)?

Injuries?

Investigations:

Bloods (full blood count, urea and electrolytes, liver function tests, glucose, and calcium)?

12-lead electrocardiogram (ECG)?

Differential diagnosis

Management:

According to cause

Reference(s):

NICE CKS: Epilepsy