Seizure Assessment and Diagnosis

Pre-Seizure Evaluation

The European Society of Cardiology recommends asking about warning signs or auras before the seizure, such as rising sensations in the abdomen, unusual smells, visual changes, or other repetitive sensations 1
The American College of Emergency Physicians suggests inquiring about potential triggers including sleep deprivation, alcohol use, medication non-compliance, or emotional stress 3, 4
The American College of Emergency Physicians advises questioning about prescribed medications that might lower seizure threshold or illicit substance use 3

The European Society of Cardiology recommends questioning witnesses about specific movements during the event, including synchronous jerking movements of arms/legs or rigid extension 1
The European Society of Cardiology suggests asking if consciousness was lost completely or altered, and whether the patient fell 1
The European Society of Cardiology advises inquiring about urinary incontinence or tongue biting, though urinary incontinence alone is not diagnostic 1

The European Society of Cardiology recommends asking how the patient felt upon regaining consciousness, as confusion or sleepiness lasting more than a few minutes suggests epilepsy 1
The American College of Emergency Physicians suggests questioning about muscle pains lasting hours or days after the event 1
The American College of Emergency Physicians advises asking if this is a first-time seizure or part of a known seizure disorder 6

The American College of Emergency Physicians recommends inquiring about history of head trauma, stroke, CNS infections, or other neurological conditions 6
The American College of Emergency Physicians suggests asking about recent alcohol use or potential alcohol withdrawal 2
The American College of Emergency Physicians advises questioning about metabolic disorders, including diabetes, and current medications, particularly antiepileptic drugs and recent compliance 2, 3, 5

The European Society of Cardiology warns against relying solely on urinary incontinence to distinguish epileptic seizures from syncope, as this can occur in both conditions 1
The European Society of Cardiology advises remembering that movements can occur during syncope and are often misinterpreted as epileptic seizures 1
The European Society of Cardiology suggests being aware that transient ischemic attacks rarely cause true loss of consciousness, and if consciousness is lost without other neurological features, TIA is unlikely 1
The American College of Emergency Physicians recommends avoiding diagnosing alcohol withdrawal seizures without excluding other causes, especially in first-time seizures 2, 5