Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

536 Epilepsies

Epilepsies..........................................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■History of recurrent seizures (ie, stereotyped episodes of motor, sen-

sory or behavioral disturbance or LOC)

■Seizures occur unpredictably but may be precipitated by certain sit-

uations (eg, stress, sleep deprivation, flickering lights)

■Pt may be unaware of seizure occurrence

■Seizures may be followed by headache, confusion, drowsiness or

focal deficits

■May be history of preceding CNS injury or infection, drug or alcohol

abuse

■May be family history of epilepsy

■May be no abnormal finding

■Focal abnormalities in pts w/ underlying structural disorder

■Cognitive deficits or multifocal or generalized deficits if seizures sec-

ondary to diffuse cerebral pathology

■Dysmorphic features or cutaneous abnormalities in certain epileptic

syndromes

tests

■Lab tests: CBC, differential count, FBS, Ca, liver & kidney function

tests, VDRL

■EEG to support diagnosis & to characterize, localize & determine

prognosis of seizures

■Cranial CT scan or MRI: to detect underlying structural lesion (espe-

cially w/ focal seizures or seizure onset after age 20 yr)

differential diagnosis

■TIAs distinguished from focal seizures by their lack of spread & neg-

ative symptomatology (loss of motor or sensory function)

■Panic attacks usually relate to external circumstances; may be evi-

dence of psychopathology btwn attacks

■Rage attacks consist of goal-directed aggressive behavior

■Syncopal attacks preceded by sweating, nausea, malaise, pallor; LOC

assoc w/ little (if any) motor activity, recovers rapidly w/ recumbency,

no postictal confusion

■Cardiac arrhythmia: may be history of cardiac disease, heart murmur

or arrhythmia; attacks may relate to physical activity