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• W4256155192 abstract "EpilepsiaVolume 44, Issue s6 p. 23-24 Free Access Diagnosis of Epilepsy First published: 18 August 2003 https://doi.org/10.1046/j.1528-1157.44.s6.7.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The diagnosis of a seizure is based on the appearance of characteristic symptoms or signs. Thus, the diagnosis does not depend primarily on the results of tests, but on the information obtained after a detailed interview with the patient and the witnesses of the seizure, and on performing a neurological examination. Once the presumptive diagnosis of a seizure is made, complementary tests are performed to confirm the diagnosis and to look for an aetiology. INITIAL DIAGNOSIS The first step towards diagnosing epilepsy lies in identifying the type of seizure, the precipitating factors, and ruling out pseudoseizures. Seizure type The major distinction to make is whether the seizure is focal (partial or secondarily generalised) or generalised (see “Definition of Epilepsy,” pages 15–16). The clinical manifestations of seizures are important clues towards the diagnosis. For example, the presence and type of sensations just before the seizure (the “aura”) point towards partial seizures (localisation-related epilepsy). The presence of automatic movements or postures, convulsive movements restricted mainly to one side of the body during the seizure, or the presence of neurological signs after the seizure (aphasia, paresis) also suggest a partial seizure 1. Precipitating factors Certain seizures are precipitated by sleep deprivation or alcohol consumption or, rarely, by sound, light or touch (reflex seizures). Pseudoseizures Seizures cannot always be clearly distinguished from a variety of nonepileptic events. Examples are syncope, tics and paroxysmal dystonias, and certain types of strokes or headaches. However, the most frequent type of pseudoseizure is the psychogenic seizure. The diagnosis of psychogenic seizures is often difficult to establish and a prolonged video-electroencephalogram (video-EEG) recording is often necessary to confirm it. DIAGNOSTIC TOOLS In the majority of patients with epilepsy, diagnosis can be made with a detailed neurologic history and examination, an EEG, and a computed tomography (CT), and/or a magnetic resonance imaging (MRI) scan. However, in certain patients, diagnosis requires recording the seizures during inpatient video-EEG monitoring. Patients who usually require this sophisticated diagnostic procedure are those in whom the clinical diagnosis is obscure or those who require precise seizure localisation in order to pursue epilepsy surgery 2. CONFIRMATION OF DIAGNOSIS Once the diagnosis of the type of seizures has been proposed, confirmation is sought by means of an EEG. The presence and localisation of the paroxysmal activity in between seizures (interictal activity) can confirm the diagnosis and substantiate the type of epilepsy (location-related or generalised). DETERMINATION OF AETIOLOGY The third step in the diagnosis is to determine the aetiology of the epilepsy. To perform an accurate aetiologic diagnosis, an MRI scan is needed. This might show a variety of lesions (tumours, scars, brain malformations) possibly responsible for the epilepsy 3. MRI is not necessary in clear-cut idiopathic epilepsies. In certain patients, for example those with refractory myoclonic epilepsy (see “Refractory Epilepsy,” pages 81–82), other diagnostic tests are necessary to reach an aetiologic diagnosis (e.g., enzyme determination in leukocytes or cultured fibroblasts). Symptomatic epilepsies Symptomatic epilepsies are mostly localization related and secondary to tumours, focal cortical dysplasia, or past brain injuries (neonatal hypoxia, severe brain trauma, encephalitis, etc). Some infantile epileptic encephalopathies are considered symptomatic and generalised. Cryptogenic epilepsies These are presumed to be symptomatic but have an unknown aetiology. Most localisation-related epilepsies without an underlying lesion, or in which a lesion can not be shown, are cryptogenic. Idiopathic epilepsies Idiopathic epilepsies are those for which no cause is found. Patients with idiopathic epilepsies have normal intelligence, examination is normal, and a genetic origin is implied. Most of the idiopathic epilepsies are generalised. (See also “Aetiology of Epilepsy,” pages 21–22.) SYNDROME CLASSIFICATION The final step in the process of diagnosing a seizure disorder lies in classifying the epilepsy into a syndrome according to the International League Against Epilepsy Classification 4. Classification is of importance for providing treatment and for giving the patient a prediction as to the course and prognosis of his/her epilepsy (see “Definition of Epilepsy,” pages 15–16) 5. RECOMMENDATION A step-wise approach to epilepsy diagnosis is required to aid determination of the type of epilepsy in order to guide patient management. REFERENCES 1 Lüders HO, Acharya J, Baumgartner C, et al. Semiological seizure classification. Epilepsia 1999; 39: 1006– 13. Wiley Online LibraryWeb of Science®Google Scholar 2 Anonymous. Assessment: intensive EEG/video monitoring for epilepsy. Neurology 1989; 39: 1101– 2. CrossrefPubMedWeb of Science®Google Scholar 3 Anonymous. Practice parameter: neuroimaging in the emergency patient presenting with seizure summary statement. Quality Standards Subcommittee of the American Academy of Neurology in cooperation with American College of Emergency Physicians, American Association of Neurological Surgeons, and American Society of Neuroradiology. Neurology 1996; 47: 288– 91. CrossrefPubMedWeb of Science®Google Scholar 4 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30: 389– 99. Wiley Online LibraryPubMedWeb of Science®Google Scholar 5 Benbadis SR, Lüders HO. Epileptic syndromes: an underutilized concept. Epilepsia 1996; 37: 1029– 34. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume44, Issues6September 2003Pages 23-24 ReferencesRelatedInformation" @default.
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• W4256155192 date "2003-08-18" @default.
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