What questions should be asked during a seizure assessment?

Essential Seizure Assessment Questions

A comprehensive seizure assessment should include specific questions about seizure characteristics, timing, triggers, and associated symptoms to accurately diagnose and manage seizure disorders. 1

Pre-Seizure Questions

• Ask about any warning signs or auras before the seizure, such as rising sensations in the abdomen, unusual smells, visual changes, or other repetitive sensations 1
• Inquire about potential triggers including sleep deprivation, alcohol use, medication non-compliance, or emotional stress 1
• Question about prescribed medications that might lower seizure threshold (e.g., tramadol) or illicit substance use (e.g., cocaine) 1
• For women of childbearing age, ask about pregnancy status as this affects testing and treatment options 2

Seizure Characteristics Questions

• Ask about the duration of the seizure - typical absence seizures rarely exceed 30 seconds, while tonic-clonic seizures typically terminate within 5 minutes 3
• Question witnesses about specific movements during the event:
  • Were there synchronous jerking movements of arms/legs (clonic) or rigid extension (tonic)? 1
  • Did movements occur before the fall or after the patient was already on the ground? 1
  • Were movements limited in scope (myoclonic) or massive synchronous jerks? 1
• Ask if consciousness was lost completely or altered, and whether the patient fell 1
• Inquire about urinary incontinence or tongue biting, though urinary incontinence alone is not diagnostic 1

Post-Seizure Questions

• Ask how the patient felt upon regaining consciousness - confusion or sleepiness lasting more than a few minutes suggests epilepsy 1
• Question about muscle pains lasting hours or days after the event 1
• Ask if this is a first-time seizure or part of a known seizure disorder 1
• For patients with known epilepsy, ask if this seizure was typical of their usual pattern 1, 4

Medical History Questions

• Inquire about history of head trauma, stroke, CNS infections, or other neurological conditions 1, 2
• Ask about recent alcohol use or potential alcohol withdrawal 1
• Question about metabolic disorders, including diabetes (for hypoglycemia) 1, 2
• Ask about current medications, particularly antiepileptic drugs and recent compliance 1
• For immunocompromised patients, ask about fever or other signs of infection 2

Pitfalls and Caveats

• Do not rely solely on urinary incontinence to distinguish epileptic seizures from syncope, as this can occur in both conditions 1
• Remember that movements can occur during syncope (convulsive syncope) and are often misinterpreted as epileptic seizures 1
• Be aware that transient ischemic attacks (TIAs) rarely cause true loss of consciousness; if consciousness is lost without other neurological features, TIA is unlikely 1
• Avoid diagnosing alcohol withdrawal seizures without excluding other causes, especially in first-time seizures 1, 2
• Consider that seizures lasting more than 5 minutes may represent status epilepticus requiring immediate intervention 5

By systematically addressing these questions, clinicians can better distinguish between epileptic seizures, non-epileptic events, and acute symptomatic seizures, leading to appropriate diagnostic testing and treatment decisions.