THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY: WHAT WILL THE PAEDIATRICIAN OR NEUROLOGIST DO?
The analysis of ‘funny turns’ or ‘blackouts’ of one sort or another makes up a considerable proportion of the work of a neurologist and quite a bit of the work of a paediatrician. Their first concern is to obtain as accurate as possible an account of the events which led up to and occurred at the time of a seizure. People who have lost consciousness cannot themselves say what happened while they were unconscious. However, people will be able to give important information about what they were doing and how they felt before loss of consciousness, and how they felt when they first recovered, but the neurologist will want to know what was happening during the time that consciousness was disturbed. For this reason an eye-witness account is essential. Information must be asked about:
• What time of day was it?
• What was the person doing before the attack?
• What were the events leading up to the seizure(s)?
• Did the seizure or attack occur without warning, or were there initial symptoms suggestive of an aura or of a simple faint (syncope)?
• What precisely did the child or person look like or do during the seizure?
• How long did the seizure or attack last?
• What did the person look like and do afterwards?
If the patient or eye-witness is unable to recall accurately exactly what happened during the seizure, then it is useful to ask the eye-witness to show the doctor what sort of ‘jerking’ or shaking occurred, but sometimes people are too shy or embarrassed to do this. If repeated attacks occur, and there remains diagnostic difficulty, the potential eye-witness should be given a list of these check points, and encouraged to use a video-camera or cam-corder to record the seizure or attack. This is becoming increasingly useful in the diagnosis of epilepsy, particularly in infants and young children.
It should be possible to make a definite diagnosis of epilepsy or of some other condition on the basis of all this clinical information.
The diagnosis of epilepsy must not be made lightly and if there is doubt then epilepsy should not be diagnosed and the doctor should wait for more convincing evidence from further ‘attacks’ or episodes before making a firm diagnosis. The risk of someone with epilepsy coming to harm from a delay in the diagnosis is small, whereas a diagnosis of epilepsy incorrectly made is nearly always damaging. This damage may be reflected in unfair prejudice and resulting social burden, in addition to the prescription of unnecessary and potentially hazardous medication.
A large number of conditions may be misdiagnosed as epilepsy particularly in children.
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