Does the patient have a history of seizures?

Medical Record Documentation of Seizure History

You must thoroughly review the patient's medical records for any documented history of seizures, including both provoked and unprovoked seizure events, as this information is critical for determining appropriate management and risk stratification. 1, 2

Essential Components to Search in Medical Records

When reviewing the patient's chart, systematically look for the following specific documentation:

Previous Seizure Events

• Any documented seizure episodes, including the date, circumstances, and whether they were witnessed or self-reported 1
• Classification of prior seizures as either provoked (occurring within 7 days of acute insult such as electrolyte abnormalities, withdrawal, toxic ingestions, encephalitis, CNS mass lesions) or unprovoked (occurring without acute precipitating factors) 3
• Remote symptomatic seizures from CNS or systemic insults that occurred more than 7 days in the past, such as history of stroke or traumatic brain injury 3

Epilepsy Diagnosis

• Formal diagnosis of epilepsy, defined as recurrent unprovoked seizures, with approximately 2-3% of the population developing epilepsy during their lifetime 4, 5
• Documentation of seizure frequency and patterns if epilepsy has been diagnosed 1

Precipitating Factors and Risk Conditions

• History of conditions that increase seizure risk, including:
  • Hypocalcemia or other electrolyte abnormalities (particularly important in patients with 22q11.2 deletion syndrome where lifetime prevalence of epilepsy is 5-7%) 3
  • Alcohol use/dependence or withdrawal history 3
  • Traumatic brain injury, cerebrovascular disease, or CNS infections 5
  • Metabolic disorders, renal failure, or liver disease 6, 7
  • Fever-related seizures or febrile convulsions 3

Medication History

• Current or past antiepileptic medications, with phenytoin (38%), levetiracetam (17%), and valproic acid (15%) being the most commonly prescribed 6
• Medications that lower seizure threshold, such as bupropion, which can cause new-onset seizures even in patients without prior seizure history 8
• Recent medication changes or discontinuations, particularly benzodiazepines (alprazolam withdrawal can reduce seizure threshold) 8

Diagnostic Testing Results

• Previous EEG results, as abnormal EEG findings predict increased risk of seizure recurrence 2
• Prior neuroimaging (CT or MRI) showing structural abnormalities such as mass lesions, stroke, cortical malformations (polymicrogyria, periventricular nodular heterotopia, cortical dysplasia) 3, 2
• Laboratory abnormalities documented in past visits, particularly glucose, sodium, calcium, and magnesium levels 3, 2

Critical Pitfalls to Avoid

• Do not overlook alternative diagnoses: Approximately 28-48% of suspected first seizures have alternative diagnoses such as syncope, nonepileptic seizures, or panic attacks 2
• Do not miss hypocalcemic seizures: These can occur at any age, even in patients with no prior history of hypocalcemia or seizures, particularly in those with underlying parathyroid dysfunction 3
• Do not assume alcohol withdrawal without documentation: Alcohol withdrawal seizures should be a diagnosis of exclusion, especially in first-time seizures, and symptomatic causes must be ruled out 2