What Matters Most When Evaluating Seizures
Ask an Expert. Neurologist Dr. Ogonna Iwuora explains how seizures are evaluated and what patients often misunderstand.
What is the first thing going through your mind when a patient comes in with a seizure?
The first question is whether this is a new event or something that has happened before. That helps guide how urgent and extensive the evaluation needs to be.
It is also important to know if anyone witnessed the episode and what it looked like. The way a seizure presents can give important clues about where in the brain it started.
What do most patients get completely wrong about seizures?
One common misconception is trying to put objects in someone’s mouth during a seizure. This can actually cause harm and should be avoided.
Another is assuming that only large, full-body seizures are serious. In reality, smaller or more subtle seizures can still be dangerous if they are not controlled. There is also a condition called sudden unexpected death in epilepsy, or SUDEP, which can occur even without dramatic seizures if epilepsy is not well managed.
What is the most surprising diagnosis you have seen hiding behind what looked like a seizure?
Some conditions can mimic seizures. For example, patients with dementia with Lewy bodies can have episodes of unresponsiveness and fluctuating cognition that resemble seizures.
Another example is anti-LGI1 encephalitis, an autoimmune condition in which patients have brief, repetitive movements that look like seizures. These episodes often do not respond to typical anti-seizure medications and instead require immunotherapy.
THE BOTTOM LINE
Not all seizures look the same, and not all seizure-like episodes are actually seizures.
The details of what happened and how it presented are critical in making the right diagnosis and treatment plan.
About the Expert
Ogonna Iwuora, MD is board-certified in neurology and neurophysiology.
This article is for educational purposes only and is not a substitute for medical advice from your own healthcare provider.