93 Epilepsy
Salient features
Examination
• Ask the patient about aura, whether she bit her tongue, whether she was incontinent during the attack, any hallucinations (déjà vu phenomenon). Ask the patient about triggering factors (including television, disco strobes, hypoglycaemia and alcohol ingestion) and whether they are recurrent. Take a family history (about 30% of patients with epilepsy have a history of seizures in relatives), and past history of head injury.
• Confirm this by asking the eye-witness about the description of seizures (note whether they were tonic–clonic), frothing at the mouth, whether the patient was unconscious or incontinent, how long the whole ‘episode’ lasted and how long she was unconscious after the attack, and whether there was any weakness after the attack (Todd’s paralysis).
• Tell the examiner that you would like to evaluate for depression (~55% of patients with uncontrolled seizures are depressed. Patients with well-controlled seizures have rates of depression that are greater than rates the general population, and suicide rates are three-fold, with the highest rates in the 6 months after diagnosis). Since antiepileptic drugs cause mood changes, it is appropriate to evaluate mood before starting therapy.
