What are the physical exam findings indicative of seizure activity in an unresponsive patient?

From the Guidelines

Seizure activity in an unresponsive patient can be indicated by tonic-clonic movements, hemilateral clonic movement, clear automatisms such as chewing or lip smacking, tongue biting, and cyanotic face 1.

Key Physical Exam Findings

• Tonic-clonic movements: usually prolonged and coincide with loss of consciousness
• Hemilateral clonic movement: indicative of seizure activity
• Clear automatisms: such as chewing or lip smacking, frothing at the mouth
• Tongue biting: more likely to occur in epilepsy if on the lateral side of the tongue
• Cyanotic face: can be seen in epilepsy or cardiac syncope

Other Relevant Findings

• Prolonged confusion and aching muscles after the event can also suggest seizure activity 1
• Myoclonus can be a manifestation of hypoxic-ischemic brain injury and may or may not be of epileptic origin 1
• EEG monitoring can be used to detect nonconvulsive seizures and status epilepticus in unresponsive patients, particularly those with a history of cardiac arrest 1

From the Research

Physical Exam Findings Indicative of Seizure Activity

The physical exam findings indicative of seizure activity in an unresponsive patient are not explicitly stated in the provided studies. However, the following points can be considered:

• A thorough history and physical examination are essential for evaluating patients with possible seizure disorders 2, 3, 4, 5.
• Clinical features that may distinguish seizures from alternative diagnoses are discussed in detail in the literature 3.
• The physical examination should direct the type and timing of laboratory and imaging studies 4.
• No single sign, symptom, or test clearly differentiates a seizure from a nonseizure event 4.

Key Points in History and Physical Examination

Some key points to consider in the history and physical examination of a patient with a possible seizure disorder include:

• Accurate description of the spell to confirm the diagnosis 3
• Careful scrutiny for previously unrecognized seizures that would change the diagnosis more definitively to one of epilepsy 3
• Identification of features more consistent with an epileptic event 5
• Laboratory studies and brain imaging to identify an acute insult contributing to the presentation 5

Diagnostic Challenges

It is essential to note that:

• The diagnosis of psychogenic nonepileptic seizures (PNES) can be challenging, and no single clinical feature is pathognomonic of PNES 6.
• A multicomponent approach to the diagnosis of PNES, with use of all available evidence, may facilitate diagnosis and care of patients with PNES 6.