Diagnostic Criteria and Clinical Characteristics
The diagnosis of epilepsy is made clinically and relies largely on a detailed clinical history. The history should include triggers, prodromal symptoms, complete description of the event, and postevent symptoms but history may need to be confirmed by appropriate tests, including an electroencephalogram (EEG) when the clinical suspicion for epilepsy is high (note, however, that a normal EEG does not rule out a clinical diagnosis of epilepsy).
The differential diagnosis of epilepsy includes syncope, nonepileptic seizures, migraine (epileptic auras arising from the occipital lobe may be mistaken for typical visual migraine auras), movement disorders (paroxysmal dystonia or hyperplexia), metabolic disturbances, sleep disorders (confusional arousals and other parasomnias, rapid eye movement [REM] sleep behavior disorder, cataplexy).
When assessing a patient for a potential genetic cause of epilepsy, one should undertake a detailed history starting with the gestational and birth history and focusing on the timing of onset of epilepsy and specific seizure types that occurred at each stage. When seeing an adult with epilepsy, particularly if the individual is intellectually disabled, it is important to attempt to obtain detailed records or to speak with a parent or caregiver ...