Evaluation approach
Epilepsy evaluation starts with event narrative, witness account and neurological exam. EEG helps characterize seizure type and may show epileptiform discharges; MRI is considered to exclude structural causes, especially in new-onset or drug-resistant epilepsy. Labs exclude provoked causes such as infection or metabolic disturbance. A single seizure does not equal epilepsy — classification follows ILAE criteria.
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Safety counseling and follow-up
Sleep hygiene, medication adherence, trigger avoidance, and counseling on recurrence risk and driving restrictions are individualized. For people with epilepsy, ongoing management is planned with the same consultant for continuity. Education covers rescue medication plans and when to seek emergency care.
- Medication adherence — most preventable seizures occur when doses are missed
- Sleep hygiene — sleep deprivation lowers seizure threshold
- Driving restrictions — individualized based on seizure control
- Safety planning — bathing, swimming, heights precautions
When urgent care is needed
First seizure needs same-day evaluation; seizure lasting over 5 minutes, repeated without recovery, or with injury or breathing difficulty is an emergency — call emergency services immediately.
- First seizure — urgent same-day evaluation
- Prolonged (>5min) or clustered — emergency
- Injury or breathing difficulty — emergency