Relevant medical history
A complete medical history including: seizure history, birth history, growth and development history, history of febrile convulsions, and family history can provide more clues for the diagnosis of epilepsy.
1. Seizure history
A complete and detailed seizure history can be very helpful in distinguishing whether a seizure is a seizure, the type of seizure, and the diagnosis of epilepsy and epilepsy syndrome. Because epilepsy is a seizure disorder with a short seizure duration, most patients are in the interictal period when they visit the doctor, and the probability of the physician witnessing a seizure is very small, therefore it is necessary to interview the patient and his relatives or colleagues to obtain a detailed and complete seizure history. A complete seizure history is the key to an accurate diagnosis of epilepsy.
(1) Age at first seizure: A significant proportion of seizures and epilepsy syndromes have a specific age range for onset.
(2) Whether there is an “aura” before the grand mal seizure: that is, the first sensation or manifestation that the patient perceives just moments before the seizure, which is actually a partial seizure. Many patients and their families come to the clinic, often focusing on the tonic clonic seizure (often referred to as grand mal seizure), but the aura symptoms before the grand mal seizure is not mentioned, thus misleading clinicians to make a diagnosis of a full-blown seizure (in fact, partial secondary to a full-blown seizure).
Clinically, patients with tonic clonic seizures, especially adult patients, should be asked in detail whether they have “aura” before the seizure, the most common aura such as nausea, panic, rising gas, fear, déjà vu, hallucinations or hallucinations, one side of the mouth twitching, etc.. But in infants and young children often can not or will not express, then the main observation of the behavior before the attack, such as: panic-like, fearful screams, running to the mother, or suddenly stop activities.
These manifestations are often very vague, but their regular appearance before the seizure suggests that the seizure may have a focal origin. The unchanging aura before the seizure not only helps to diagnose partial seizures, but is also important for localization of the lesion.
(3) Details of the seizure process: whether the seizure occurs in the waking or sleeping state, whether there is loss of consciousness, whether there is tonic or clonic jerking of the limbs, whether there is fall and incontinence, whether the seizure is manifested by jerking of one or both limbs, whether the head is turned to one side or whether the eyes are tilted to one side, the duration of the seizure, the post-seizure state, whether there is headache, vomiting, post-seizure delirium and Todd’s palsy. (4) There are several types of seizures.
(4) There are several types of seizures: Some patients with a long history may only describe the most recent seizures or focus on the more severe ones, but rarely mention previous seizures or less severe ones (e.g., “frothy” petit mal seizures), which inevitably affects the clinician’s assessment of the overall condition and the correct diagnosis of the epilepsy syndrome. This inevitably affects the clinician’s assessment of the overall condition and the correct diagnosis of the syndrome. It is important to ask about the early seizures, any changes in the form of subsequent seizures, and the last seizure, as the most recent seizures are the most clearly remembered.
(5) Frequency of seizures: how many seizures per month or per year on average, whether there is a continuous cluster of seizures in a short period of time, the longest and shortest interval between seizures, etc. In particular, the monthly seizure frequency (and its average) in the last 1 to 3 months. This can be used to assess the severity of the seizures and also as a good basis for assessing the efficacy of future treatment.
(6) Whether the attack is triggered by sleep deprivation, excessive alcohol consumption, fever, excessive fatigue, emotional stress, or a specific stimulus. In women, whether it is related to menstruation, which is useful for differential diagnosis, treatment and prevention. If staying up for several days in a row may also cause convulsive seizures in healthy people, do not draw premature conclusions, and continue to follow up.
(7) Whether antiepileptic drug treatment is applied and its effect.
2. Birth history
Whether the birth was at full term, whether the birth was smooth, whether there was asphyxia or birth injury, etc. The mother should also be asked what kind of disease she had during the pregnancy. Abnormal birth history makes it easier for epilepsy to occur during growth, especially in infants or children with suspected epilepsy.
Growth and developmental history
It is important to understand neuropsychiatric development, including motor, language, and intellectual development, which can be helpful in classifying epilepsy and identifying specific syndromes.
4. History of febrile convulsions
Patients with a history of febrile convulsions have a higher chance of developing epilepsy than normal, and are especially prone to certain types of seizures and epilepsy.
5. Family history
If there are patients with epilepsy or convulsive seizures in the family, especially if the specific seizure manifestations are similar to those of the suspect, it can provide positive information for diagnosis.
6. History of other diseases
The presence or absence of a clear history of brain injury or lesions such as a history of cranial trauma, central system infection, or central nervous system tumor can suggest the etiology of epilepsy.
Physical examination
The physical examination includes a general medical system examination and a neurological examination. The focus should be on the neurological system, paying attention to the patient’s mental status and intelligence, noting whether the patient’s speech is normal, and when examining the eyes, attention should be paid to examining the fundus. Physical examination is helpful in the diagnosis of the etiology of epilepsy.