Examining a patient after an epileptic seizure

The first physician attending to the patient should establish and record the course of the seizure, including pre-ictal as well as post-ictal signs and symptoms. Eyewitness accounts of the event are of utmost importance and should be obtained immediately after the seizure, e.g. from a person accompanying the patient who saw the event, either in person or by telephone. This may be crucial for diagnosis. The patient should be referred for neurological investigations for the confirmation of the diagnosis and for aetiological studies (in adult-onset epilepsy, a brain tumour should be considered as a possible cause). Brain imaging should be arranged quickly, but not necessarily as an emergency. The diagnostic approach after a first seizure associated with alcohol withdrawal should be the same as after an epileptic seizure, i.e. a single brain scan is warranted. If an episode of unconsciousness is not clearly epileptic in nature, an adult patient will often primarily need cardiac investigations.