11/13/24, 8\:12 PM Guide | Seizure history

Seizure history

Table of contents

Introduction

Taking a history from a patient presenting after a suspected seizure is an important skill that is often assessed in OSCEs. This
guide provides a structured approach to taking a seizure history in an OSCE setting.

Background

Transient loss of consciousness (TLOC)

Loss of consciousness seen by lay people is a sudden change in behaviour, where people suddenly change body posture and
become unresponsive. This may be accompanied by a complete absence of movement, or excessive abnormal movements
(which people may say is a seizure). These episodes can be due to inadequate brain perfusion (syncopal episodes) or seizure
activity.
This article will cover taking a history from an adult patient following a seizure, and it assumes that there was witnessed limb
jerking or other features suggestive of a seizure.
For more information on other causes of loss of consciousness (besides seizures), see the Geeky Medics guide to taking a
history from a patient with loss of consciousness. We also have a summary of syncope which might be helpful.

Seizures

Seizures are clinical manifestations of abnormal synchronous discharges of neurones.
1
Epilepsy is often used synonymously with the term seizures, but there are other causes of seizures besides epilepsy.
Epilepsy refers to a large group of syndromes where there is a predisposition to having seizures. Epilepsy has many
underlying aetiologies broadly categorised as genetic, structural, immune, infectious, metabolic or unknown. 2
A diagnosis of
epilepsy may be suspected following a seizure episode, but a specialist assessment is required to make a diagnosis of
epilepsy.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain that you’d like to take a history from the patient.
Gain consent to proceed with history taking.
General communication skills
It is important you do not forget the general communication skills which are relevant to all patient encounters.
Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because
you're running through a checklist in your head doesn't mean this has to be obvious to the patient).
Some general communication skills which apply to all patient consultations include\:
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Demonstrating empathy in response to patient cues\: both verbal and non-verbal.
Active listening\: through body language and your verbal responses to what the patient has said.
An appropriate level of eye contact throughout the consultation.
Open, relaxed, yet professional body language (e.g. uncrossed legs and arms, leaning slightly forward in the chair).
Making sure not to interrupt the patient throughout the consultation.
Establishing rapport (e.g. asking the patient how they are and o
Signposting\: this involves explaining to the patient what you have discussed so far and what you plan to discuss next.
Summarising at regular intervals.

Presenting complaint

Use open questioning to explore the patient’s presenting complaint\:
“ W h a t’ s b r o u g h t y o u i n t o s e e m e t o d a y ?”
“ T e l l m e a b o u t t h e i s s u e s y o u’ v e b e e n e x p e r i e n c i n g.”
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presenting complaint if required\:
“ O k , c a n y o u t e l l m e m o r e a b o u t t h a t ?”
“ C a n y o u e x p l a i n w h a t t h a t p a i n w a s l i k e ?”
Open vs closed questions
History taking typically involves a combination of open and closed questions. Open questions are e
consultations, allowing the patient to tell you what has happened in their own words. Closed questions can allow you to
explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation.
Closed questions can also be used to identify relevant risk factors and narrow the di

History of presenting complaint

With many seizures involving reduced or absent awareness, it is essential to obtain a collateral history.
It is important to identify patients who have had a seizure, as opposed to common mimics (e.g. syncope) and to establish what
happened before, during and after the event.
Once you have a high suspicion that the event was a seizure, consider why they have seized, and how this is going to a
the individual (covered in the past medical and social history).

Immediately before the event

Is there anything that indicates this may be a syncopal episode?
Cardiogenic syncope\:
" B e f o r e t h e e v e n t d i d y o u f e e l s w e a t y , h o t , l i g h t h e a d e d , b r e a t h l e s s , o r h a v e c h e s t p a i n o r
p a l p i t a t i o n s ?" " W e r e y o u e x e r t i n g y o u r s e l f b e f o r e t h i s h a p p e n e d ?"
Orthostatic\:
"Were y o u s i t t i n g o r s t a n d i n g f o r a l o n g t i m e ?" " W e r e y o u i n a h o t o r s t u
Postural syncope\:
" D i d y o u m o v e f r o m s i t t i n g t o s t a n d i n g, o r l y i n g t o s t a n d i n g i m m e d i a t e l y b e f o r e t h i s h a p p e n e d ?"
Is there a non-syncopal mimic at play?
Rigors (can often be mistaken for seizures)\:
febrile seizures.
" D i d y o u f e e l l i k e y o u h a d a t e m p e r a t u r e ? – Remember that children can have
Transient ischaemic attack\:
" D i d t h i s h a p p e n w h i l e y o u w e r e l o o k i n g u p a t s o m e t h i n g ?"
- Shaking limb TIAs can be caused
by reduced brain perfusion before onset, such as neck hyperextension, or lying to standing. Suspicion of this can be further
raised if there was no loss of consciousness.
3
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Establish if there was any abnormal brain activity (e.g. aura or focal seizures) before the event\:
" D i d y o u e x p e r i e n c e a n y a b n o r m a l s e n s a t i o n s b e f o r e t h e e v e n t ?"
- Focal seizures may be heralded by a subjective sensory
aura. The aura will be determined by the area of the cortex a
by smell disturbance, a rising sensation in the epigastrium, palpitations, or déjà vu/jamais vu.
1
" D i d y o u h a v e a n y a r m o r l e g w e a k n e s s b e f o r e t h e e p i s o d e ?"
" D i d y o u
" D i d y o u h a v e a n y m o v e m e n t s t h a t y o u f e l t y o u w e r e n o t d o i n g v o l u n t a r i l y ?"
" D i d y o u , o r a n y o n e a r o u n d y o u , n o t i c e a n y c h a n g e t o y o u r b e h a v i o u r b e f o r e t h e e p i s o d e ?"
Ask about features suggestive of the underlying aetiology of the seizure\:
4,5,6
" D i d y o u h a v e a h e a d a c h e b e f o r e t h e e p i s o d e s t a r t e d ?"
- This may herald a serious underlying vascular pathology such as a
subarachnoid haemorrhage
" H a d y o u h a d a n y f a l l s o r h e a d i n j u r i e s b e f o r e t h i s e p i s o d e s t a r t e d ?"
- In older people, it can take subdural haemorrhages
days to weeks to manifest clinically
" H a v e t h e r e b e e n a n y a b n o r m a l m o v e m e n t s i n y o u r l i m b s o r f a c e n o t i c e d b y y o u r s e l f o r a n y o n e e l s e ?"
- Abnormal
hyperkinetic disorders may indicate a potential underlying autoimmune encephalitis
With all of these features, it is important to clarify how close in time they happened to the seizure.

During the event

Seizure semiology (the clinically observed pattern of motor, sensory, behavioural, or psychiatric changes during a seizure) has
been classiInternational League Against Epilepsy (Table 1).
Table 1. The classi
Focal onset
T h e s e i z u r e i s l i k e l y t o i n v o l v e
p a r t o f t h e b r a i n
Generalised onset Unknown onset
Aware
Motor
Motor onset
O f s e l f a n d
Impaired
Tonic-clonic
Tonic-clonic
e n v i r o n m e n t ;
f o r m e r l y
k n o w n a s
awareness
Other motor
Epileptic spasms
O f s e l f a n d
Nonmotor (absence)
Nonmotor onset
e n v i r o n m e n t
s i m p l e p a r t i a l
s e i z u r e
Behaviour arrest
Motor onset
Automatisms - repeated
stereotyped movements
Atonic
Clonic
Epileptic spasms
Unclassi
Hyperkinetic
Myoclonic
Tonic
“ D u e t o i n a d e q u a t e
i n f o r m a t i o n o r i n a b i l i t y t o
p l a c e i n o t h e r c a t e g o r i e s .
”
Nonmotor onset
Autonomic
Behaviour arrest
Cognitive*
Emotional**
Sensory
*impaired language or other cognitive domains or positive features such as déjà vu, hallucinations, illusions, or perceptual
distortions
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**involve anxiety, fear, joy, other emotions, or appearance of a
Can you
Did anyone record what happened on video?
Has another healthcare professional recorded a description of the event? Sometimes the paramedics will have written a
detailed account of what happened at the scene.
From collateral history taking, identify core features of the episode in terms of the above seizure descriptions\:
" W a s t h e p a t i e n t a l e r t o r u n r e s p o n s i v e ?"
" W a s t h e r e a b r u p t g e n e r a l i s e d m u s c l e s t i
- this indicates a tonic seizure
" W a s t h e r e g e n e r a l i s e d s t i
- this indicates a tonic-clonic seizure
" D i d t h e y s t o p w h a t t h e y w e r e d o i n g a n d b e c o m e v a c a n t ?"
- this indicates an absence seizure
" W a s t h e r e a s u d d e n l o s s o f m u s c l e t o n e ?"
- atonic seizure
" W e r e t h e r e a n y r e p e t i t i v e m o v e m e n t s o f t h e f a c e o r l i m b s ?"
Identify other features that indicate seizure or non-seizure activity\:
7-11
- patients may enact learned behaviours in automatisms
" W a s t h e r e a n y h e a d t u r n i n g ?"
- Head turning to one side may indicate a seizure - if the head is turning side to side during
the event, non-epileptic seizures may be the underlying aetiology
" W e r e t h e i r e y e s l o o k i n g o n e w a y o r t h e o t h e r ?"
- Eye deviation to one side may indicate a seizure
" W a s t h e r e a n y t o n g u e b i t i n g ?"
- Lateral tongue biting is purported to be a reliable sign of generalised motor seizure activity,
although the evidence is not brilliant
" W a s t h e r e a n y p e l v i c t h r u s t i n g ?"
- This is a very sensitive but non-speci
" D i d t h e i r s k i n o r l i p s g o b l u e ?"
- Cyanosis occurs when the proportion of carbon dioxide (CO ) in the blood reaches a certain
2
level - it may develop in generalised seizures due to airway occlusion and lack of ventilation. Cyanosis early on in the event
may indicate another cause of CO 2
accumulation that precipitates seizure activity. Cyanosis occurring later on during an
episode suggests it is likely a seizure causing hypoventilation
" D i d t h e y g o p a l e ?"
- Pallor at the start of an event is suggestive of hypoperfusion as a result of a syncopal event
Historically, healthcare professionals have been taught to ask about incontinence. However, this is not a speci
seizures, as people may have incontinence with any type of loss of consciousness.
7,9

Following the event

How was the seizure stopped? Ask the following from collateral or documentation available\:
" H o w l o n g d i d i t t a k e f o r t h e s e i z u r e t o s t o p ?"
- Knowing the duration of the seizure is helpful in understanding the risk of
sequelae such as hypoxic brain injury in generalised seizures
" D i d a n y d r u g s n e e d t o b e g i v e n f o r t h e s e i z u r e t o s t o p ?"
- This information can be gained from paramedic reports. The time
course is important as this may a
Are there post-ictal features that increase suspicion of a seizure? Post-ictal phenomena predominantly only occur in
generalised tonic, clonic, or tonic-clonic seizures\:
7,9,12
" W h e n t h e e p i s o d e s t o p p e d h o w l o n g w a s t h e p a t i e n t u n c o n s c i o u s f o r ?"
- Greater than 5 minutes of loss of consciousness
after the event is suspicious for a seizure
" D i d y o u / t h e y k n o w w h e r e t h e y w e r e w h e n t h e y w o k e u p ?"
" C a n y o u / t h e y r e c a l l w h a t h a s h a p p e n e d s i n c e t h e s e i z u r e i n - People may be disorientated after a seizure
- Anterograde amnesia may occur after seizures
f u l l ?"
" D i d y o u f e e l s l e e p y o r t i r e d a f t e r t h e e v e n t ?"
" D i d y o u h a v e m u s c l e p a i n a f t e r t h e e v e n t ?"
- Uncontrolled muscle contraction will cause soreness
" H a v e y o u b i t t e n t h e s i d e o f y o u r t o n gu e ?"
- Lateral tongue biting may indicate a generalised seizure
Tongue biting and prolonged unresponsiveness with the absence of typical syncopal symptoms at onset is strongly
suggestive of a seizure.
7
Are there any sequelae of the seizure?
" D o y o u h a v e a n y j o i n t p a i n o r d i
during generalised seizures
- Injuries including dislocations and trauma may have occurred
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" A r e y o u c o u g h i n g a n y t h i n g u p ?" or " D i d t h e y s e e m t o a s p i r a t e a n y t h i n g d u r i n g t h e e v e n t ?"
generalised seizures are at high risk of aspirating secretions
- Patients who have had

Ideas, concerns and expectations

A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to
gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the
consultation.
The exploration of ideas, concerns and expectations should be
This will help ensure your consultation is more natural, patient-centred and not overly formulaic.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided several
examples for each of the three areas below.
Ideas
Explore the patient's ideas about the current issue\:
" W h a t d o y o u t h i n k t h e p r o b l e m i s ?"
" W h a t a r e y o u r t h o u g h t s a b o u t w h a t i s h a p p e n i n g?"
" I t’ s c l e a r t h a t y o u’ v e g i v e n t h i s a l o t o f t h o u g h t a n d i t w o u l d b e h e l p f u l t o h e a r w h a t y o u t h i n k m i gh t b e go i n g o n .
"
Concerns
Explore the patient's current concerns\:
" I s t h e r e a n y t h i n g , i n p a r t i c u l a r , t h a t’ s w o r r y i n g y o u ?"
" W h a t’ s y o u r n u m b e r o n e c o n c e r n r e ga r d i n g t h i s p r o b l e m a t t h e m o m e n t ?"
" W h a t’ s t h e w o r s t t h i n g y o u w e r e t h i n k i n g i t m i gh t b e ?"
Expectations
Ask what the patient hopes to gain from the consultation\:
" W h a t w e r e y o u h o p i n g I’ d b e a b l e t o d o f o r y o u t o d a y ?"
" W h a t w o u l d i d e a l l y n e e d t o h a p p e n f o r y o u t o f e e l t o d a y’ s c o n s u l t a t i o n w a s a s u c c e s s ?"
" W h a t d o y o u t h i n k m i g h t b e t h e b e s t p l a n o f a c t i o n ?"

Summarising

Summarise what the patient has told you about their presenting complaint. This allows you to check your understanding of
the patient's history and provides an opportunity for the patient to correct any inaccurate information.
Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Continue to periodically
summarise as you move through the rest of the history.

Signposting

Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to
discuss next. Signposting can be a useful tool when transitioning between di
provides the patient with time to prepare for what is coming next.
Signposting examples
Explain what you have covered so far\:
a c h i e v e t o d a y .
"
" O k , s o w e’ v e t a l k e d a b o u t y o u r s y m p t o m s , y o u r c o n c e r n s a n d w h a t y o u' r e h o p i n g w e
What you plan to cover next\:
h i s t o r y .
”
“ N e x t I’ d l i k e t o q u i c k l y s c r e e n f o r a n y o t h e r s y m p t o m s a n d t h e n t a l k a b o u t y o u r p a s t m e d i c a l

Systemic enquiry

A systemic enquiry involves performing a brief screen for symptoms in other body systems which may or may not be relevant
to the primary presenting complaint. A systemic enquiry may also identify symptoms that the patient has forgotten to mention
in the presenting complaint.
Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience.
Some examples of symptoms you could screen for in each system include\:
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Systemic\: fevers (e.g. cerebral abscess, meningitis), weight change (e.g. malignancy), confusion (e.g. CNS infection)
Cardiovascular\: palpitations (e.g. arrhythmia), chest pain (acute coronary syndrome), shortness of breath (e.g. heart failure)
Respiratory\: dyspnoea, cough (e.g. pneumonia), pleuritic chest pain (e.g. pulmonary embolism)
Gastrointestinal\: diarrhoea, vomiting (e.g. dehydration/hypotension/electrolyte disturbances)
Genitourinary\: oliguria (e.g. dehydration/hypotension)
Neurological\: visual symptoms (e.g. pre-syncope), headache (e.g. brain tumour), meningism (e.g. CNS infection), motor or
sensory disturbances (e.g. stroke)
Musculoskeletal\: head injury (e.g intracranial haemorrhage), trauma (e.g. secondary to syncope), joint swelling/pain (e.g.
lupus/vasculitis)
Dermatological\: rashes (e.g. meningococcal sepsis, Lupus, vasculitis)

Past medical history

History of epilepsy
Ask if the patient is known to have epilepsy and ask about details of their condition\:
13
" W h a t d o y o u r s e i z u r e s n o r m a l l y l o o k l i k e ?"
" W h e n w a s t h e l a s t s e i z u r e y o u h a d b e f o r e t h i s o n e ?"
" W a s t h i s e p i s o d e l i k e y o u r n o r m a l s e i z u r e s o r w a s t h i s a d i
- It is important to note that there is a
higher risk of non-epileptic attacks in an epileptic patient. Patients can have both epilepsy and non-epileptic attack disorder.
If the patient has epilepsy, explore if there are any triggers which may be lowering their seizure threshold\:
" H a v e y o u b e e n u n d e r m o r e s t r e s s r e c e n t l y ?"
" H a v e y o u h a d a n y d i s r u p t i o n t o y o u r s l e e p p a t t e r n ?"
" D i d y o u c o n s u m e a n y a l c o h o l o r r e c r e a t i o n a l d r u gs b e f o r e t h i s e p i s o d e ?"
" H a v e y o u b e e n r e m e m b e r i n g t o t a k e y o u r m e d i c a t i o n ?"
" H a v e y o u s t a r t e d t a k i n g a n y n e w p r e s c r i b e d d r u gs , o v e r-t h e-c o u n t e r d r u g s , o r s u p p l e m e n t s ?
Other medical conditions
Ask if the patient has any other medical conditions\:
" D o y o u h a v e a n y o t h e r m e d i c a l c o n d i t i o n s ?"
" A r e y o u c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e g u l a r l y ?"
If the patient does have a medical condition, you should gather more details to assess how well controlled the disease is and
what treatment(s) the patient is receiving. It is also important to ask about any complications associated with the condition
including hospital admissions.
Ask if the patient has previously undergone any surgery or procedures (e.g. coronary artery bypass grafts, pacemaker
insertion)\:
" H a v e y o u e v e r p r e v i o u s l y u n d e r g o n e a n y o p e r a t i o n s o r p r o c e d u r e s ?"
" W h e n w a s t h e o p e r a t i o n / p r o c e d u r e a n d w h y w a s i t p e r f o r m e d ?"
Examples of relevant medical conditions
Medical conditions relevant to seizures include\:
12
Structural CNS abnormalities\: congenital malformations, vascular malformations (e.g. cavernomas), previous strokes
Diabetes and hypertension\: may cause chronic small vessel ischaemia in deep white matter that can predispose to
seizures
Neurodegenerative conditions (e.g. Alzheimer's)
Endocrine or metabolic conditions\: can cause depression in CNS activity if poorly controlled
Dialysis patients\: electrolyte shifts may predispose to seizures after dialysis
Immunosuppression\: either pharmacologically (e.g. renal transplant) or pathologically (e.g. immunode
may predispose the patient to CNS infections that may manifest as seizures.
Autoimmune/rheumatological conditions\: lupus and vasculitis may predispose to seizures through CNS vasculitis.
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Chronic infections\: some treatments associated with chronic infections can promote infection. For example, isoniazid
(used for tuberculosis) a
Allergies
anaphylaxis).
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. mild rash vs

Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies\:
“ A r e y o u c u r r e n t l y t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s o r o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
If the patient is taking prescribed or over-the-counter medications, document the medication name, dose,
frequency, form and route.
Ask if the patient has recently started any medications which may have precipitated a seizure (e.g. nefopam) or caused a
syncopal episode (e.g. antihypertensive)\:
14
" H a v e y o u r e c e n t l y s t a r t e d a n y n e w m e d i c a t i o n s ?"
- Some antibiotics can reduce the seizure threshold through interaction
with antiepileptics (e.g. meropenem reduces the therapeutic plasma levels of sodium valproate)
Ask the patient if they’re currently experiencing any side e
“ H a v e y o u n o t i c e d a n y s i d e e
Ask the patient if they've recently stopped any medications or had any doses changed as this may have precipitated a seizure
(e.g. gabapentin withdrawal) or resulted in hypotension (e.g. corticosteroid withdrawal causing adrenal insu
" H a v e y o u r e c e n t l y s t o p p e d a n y m e d i c a t i o n s ?"
Ask if the patient is following a speci
medications, or be directly toxic.
Medication examples
Medications relevant to seizures include\:
Hypoglycaemic agents\: increased risk of hypoglycaemia and seizures
Anticonvulsants\: if doses recently changed may precipitate a seizure
Tricyclic amines\: associated with orthostatic hypotension and seizures
Short-acting benzodiazepines\: associated with seizures upon withdrawal
Contraceptive pills\: some antiepileptic medications can a
less e

Family history

Ask the patient if there is any family history of seizures\:
“ D o a n y o f y o u r p a r e n t s o r s i b l i n g s h a v e a n y h e a r t p r o b l e m s o r h a v e t h e y e x p e r i e n c e d s e i z u r e s i n t h e p a s t ?”
Clarify at what age the disease developed (disease developing at a younger age is more likely to be associated with genetic
factors)\:
“ A t w h a t a g e d i d y o u r f a t h e r s u
If one of the patient’s close relatives is deceased, sensitively determine the age at which they died and the cause of death\:
“ I’ m r e a l l y s o r r y t o h e a r t h a t , d o y o u m i n d m e a s k i n g h o w o l d y o u r d a d w a s w h e n h e d i e d ?”
“ D o y o u r e m e m b e r w h a t m e d i c a l c o n d i t i o n w a s f e l t t o h a v e c a u s e d h i s d e a t h ?”
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If the patient reports unexplained sudden deaths in young relatives, consider the possibility of inherited cardiac arrhythmias
(e.g. Brugada syndrome, long QT syndrome).

Explore the patient’s social history to both understand their social context and identify potential risk factors. It is also
important to understand the lifestyle implications of seizures and explore underlying risk factors.
General social context
Explore the patient’s general social context including\:
the type of accommodation they currently reside in (e.g. house, bungalow) and if there are any adaptations to assist them
(e.g. stairlift)
who else the patient lives with and their personal support network
what tasks they are able to carry out independently and what they require assistance with (e.g. self-hygiene, housework,
food shopping)
if they have any carer input (e.g. twice daily carer visits)
Understanding the patient's daily activities allows you to consider the risk posed by further episodes of seizures. If the patient
lives alone, there is a 5-fold increased risk of sudden unexpected death in epilepsy (SUDEP).
Smoking
Record the patient’s smoking history, including the type and amount of tobacco used.
Calculate the number of ‘pack-years‘ the patient has smoked for to determine their cardiovascular risk pro
pack-years = [number of years smoked] x [average number of packs smoked per day]
one pack is equal to 20 cigarettes
Alcohol
Record the frequency, type and volume of alcohol consumed on a weekly basis.
Patients drinking signi
drinking (i.e. alcohol withdrawal seizures). Patients who binge drink are also at increased risk of seizures secondary to acute
intoxication.
Chronic alcohol excess increases the risk of epilepsy.
Recreational drug use
Ask the patient if they use recreational drugs and if so determine the type of drugs used and their frequency of use.
Recreational drugs can cause seizures, either as a direct neuroexcitatory e
Occupation
Ask about the patient’s current occupation\:
Explore what tasks the patient performs at work to identify high-risk activities (e.g. working at heights, operating heavy
machinery).
If the patient is experiencing seizures and works with heavy machinery or at heights, it is important to advise them to take
time o
The following social history elements are more speci
Driving
If the patient drives and has presented with a seizure it is important to advise them not to drive until they have been fully
investigated and to inform the relevant driving authority (e.g. Driver and Vehicle Licensing Agency - DVLA) of their current
medical issues.
It is also important to determine if they have a class 2 licence (which allows them to drive a vehicle over 7.5 tonnes) as there
will be a di
someone should continue to drive (rather than the healthcare professional).
If patients do not inform the DVLA, they will not be covered by insurance if there is another seizure episode.
Children or other dependents
If the patient is a parent with young children, you could consider asking the following\:
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Do they carry their child? There may be signi
to a carrycot and wheeling the baby alongside may be helpful. Alternatively, a baby could be strapped into a car seat and
then the car seat carried.
Feeding\: there may be concerns about antiepileptic drugs and breastfeeding; this is usually not a problem.
If breastfeeding, it is advisable for mothers to sit on the
baby does not have far to fall if the patient loses consciousness. The Royal College of Obstetricians and Gynaecologists
recommend monitoring for adverse e
If bottle feeding, a patient could consider setting a high chair at the lowest height and sitting on the
baby.
Nappy changing\: this is best carried out on a waterproof mat on the
unattended,
Sleep
Disrupted sleep may increase the risk of further seizures if there is an underlying epilepsy diagnosis. Identifying modi
sleep disruptions can be helpful.
Bathing and swimming
Advice for bathing is to only bathe when someone else is at home and able to stand outside the bathroom door. For showering,
patients should sit on a chair when having a shower.
Advice regarding swimming and water sports can be found on the Epilepsy Society website.
Family planning
Women who are planning to start a family, and have epilepsy, should consider taking a folic acid supplement of 5mg per day
to reduce the risk of birth defects.

Closing the consultation

If the patient has ongoing concerns, they can be signposted to information websites such as Epilepsy Action.
An epilepsy specialist nurse can be a helpful point of contact for the patient.
If there are ongoing concerns regarding medication in women who are pregnant, or who may be trying for a pregnancy, they
can be signposted to the Best Use of Medicines in Pregnancy (BUMPS) website.
Summarise the key points back to the patient.
Ask the patient if they have any questions or concerns that have not been addressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

Reviewer

Dr Stuart Weatherby
Consultant Neurologist
University Hospitals Plymouth

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