History taking and examination in epilepsy (clinical lecture)
A.S. Kotov, K.V. Firsov
M.F. Vladimirskiy Moscow Regional Research and Clinical Institute
The paper discusses history taking and examination of patients with epilepsy. The authors highlight the aspects which can help with differential diagnosis. Errors and omissions in the beginning of diagnostic search may later result in incorrect interpreting of diagnostic data due to the initially wrong hypothesis. Unnecessary and non-informative instrumental tests should be avoided. Reduced history taking time can result in ignoring of paroxysmal event details which are of crucial importance for its correct interpreting. The questions should be simple, clear, without professional terms. Neurological examination is the key aspect in the clinical examination of epileptic patients. When examining a patient several minutes or hours after the seizure, particular attention should be paid to postictal phenomena, i.e., Todd’s paralysis or aphasia which contribute to the localization of epileptic focus . The aim of the examination long after the seizure is to identify permanent neurological deficit which indicates symptomatic epilepsy and/or acute brain injury. Clear neurological symptoms only are diagnostically relevant.
Keywords: epilepsy, diagnostics, anamnesis, examination, neurological deficit.
For citation: Kotov A.S., Firsov K.V. History taking and examination in epilepsy (clinical lecture). RMJ. Medical Review. 2019;7:4–7.
2. Stephenson J.B.P. Fits and Faints. London: MacKeith Press; 1990.
3. Dumont-Driscoll M.C. Foreword: too little, too late, too much, too long, just right? Reinforcing the importance of a thorough history and physical exam for correct diagnosis and ongoing patient management. Curr Probl Pediatr Adolesc Health Care. 2015;45(1):1–2. DOI: 10.1016/j.cppeds.2014.12.003.
4. Fisher R.S., Cross J.H., French J.A. et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–530. DOI:10.1111/epi.13670.
5. Scheffer I.E., Berkovic S., Capovilla G. et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512–521. DOI:10.1111/epi.13709 1–3.
6. Котов А.С. Фокальные эпилепсии у взрослых: клиническая лекция. РМЖ. Медицинское обозрение. 2019;4(2):95–99. [Kotov A.S. Focal epilepsy in adults: clinical lecture. RMJ. Medical review. 2019;4(2):95–99 (in Russ.)].
7. Nowacki T.A., Jirsch J.D. Evaluation of the first seizure patient: Key points in the history and physical examination. Seizure. 2017;49:54–63. DOI:10.1016/j.seizure.2016.12.002.
8. Baranowski CJ. The quality of life of older adults with epilepsy: A systematic review. Seizure. 2018;60:190–197. DOI: 10.1016/j.seizure.2018.06.002.
9. Riechmann J., Willems L.M., Boor R. et al. Quality of life and correlating factors in children, adolescents with epilepsy, and their caregivers: A cross-sectional multicenter study from Germany. Seizure. 2019;69:92–98. DOI: 10.1016/j.seizure.2019.03.016.
10. Hingray C., McGonigal A., Kotwas I., Micoulaud-Franchi J.A. The Relationship Between Epilepsy and Anxiety Disorders. Curr Psychiatry Rep. 2019;21(6):40. DOI: 10.1007/s11920-019–1029–9.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
