History taking in epilepsy is not easy because the patient himself is not able to give details of events during attack. In majority of patients it is a relative or a close friend who comes out with the facts. The main aim of taking a detailed history and a neurological examination is to differentiate seizure and epilepsy so that the cause of epilepsy may be established. It may be noted that the symptoms and signs may change in patients on AEDs (Anti Epileptic Drugs).
The various symptom complexes that may present epilepsy are:
This is a sensation or warning felt or experienced by a patient before the onset of an attack. Here the consciousness is not altered and the patient may experience it in many forms, without losing consciousness.
It can be in the form of tingling numbness in any part of the body and headache lasting for days.
Hallucination and psyche experiences like de ja vu and jamais vu have also featured in aura.
This is the commonest presentation in patients suffering from epilepsy .The different types of seizure have already been mentioned in the classification of seizures. Here we will only discuss their presentation
Here the consciousness is altered. During this changed consciousness the patient may go into state of automatism. This is followed by amnesia about the events. It presents in many forms.
The patient may present as laughing, crying or show expression of fright and anger.
He may be lip smacking, swallowing chewing, or saliva may be dripping.
There may be movements like walking , running , and wandering off.
Sometimes the patient may try to catch something imaginary or pull at a shirt or sleeves.
There are many forms of this epilepsy. Each one will be discussed clinically and its presentation described . In all the forms consciousness is lost to the certain extent .
This is the commonest from of epilepsy in clinical practice. There may be an be aura and patient becomes unconscious, sometimes giving a loud cry and suddenly falling to the ground . the face turns to one side and body becomes stiff-tonic phase. Eyeballs move upwards. Clonic phase usually follows and the muscles go into a stage of intermittent contraction . body then goes into convulsive movements and later on becomes flaccid. The whole state lasts for a few minutes during which the patient is unconscious and frothing may occur.
The seizure is not stereotype in every attack and there may be a change in presentation.
Seen in children without any tonic phase. There is twitching and jerking movement of face and limbs
There is no symmetry or regularity in the movement
Here there is tonic contraction of the muscles without the clonic phase . The muscles of the whole body may go into tonic contraction starting form face ,neck and proximal and distal muscles of the limbs . patients may fall off and get hurt. Tonic seizures are a common feature in patients with diffuse brain damage and mental retardation
The muscle tone is suddenly lost and the patient may fall like a log. These are the classical drop attacks involving the whole body. There may be involvement of only a certain group of muscles and this may cause nodding of the head called salaam epilepsy . serious brain damage is the cause of atonic seizure.
Generally a part of idiopathic generalized epilepsy syndrome There is a brief contraction of a muscle or a group of muscles or many groups of muscles. From a minor twitching it can present as a major jerk .Loss of consciousness may not be present and the patient may go into a full-generalized tonilc clonic seizure. Sometime the jerking is so severe that objects held in the hand are thrown off like a flying saucer.