⚡️How to Approach Sudden Seizures: Differentiating Epilepsy, Emergency Response, and Essential Tests

A sudden seizure — a patient’s eyes roll back, limbs shake violently, and they lose consciousness.
It’s a scene that can unsettle anyone.
Missing a serious underlying condition by mishandling this moment could cost a life.
On the other hand, hastily labeling any convulsion as “epilepsy” can also lead to misdiagnosis.

In the OSCE (Objective Structured Clinical Examination), calmly managing such high-acuity scenarios is essential.
But how should we evaluate a patient who presents with seizures in real clinical practice?
This article will walk you through the clinical reasoning process — from initial assessment to differential diagnosis, workup strategies, and key differences between epilepsy and its mimics — with real-world, OSCE-ready approaches.

---

📘 What You Will Learn from This Article

• How to correctly identify seizure episodes
  Learn how to distinguish true seizures from other causes of loss of consciousness.
• Targeted questions and physical exam findings to narrow the differential
  Utilize OPQRST and PAM HITS FOSS frameworks to approach seizures efficiently.
• How to distinguish epilepsy from mimics
  Differentiate epilepsy from psychogenic, syncopal, infectious, or metabolic events.

---

🧑‍⚕️ Case Vignette – A Young Man Collapses in a Supermarket

“We were just shopping at the supermarket when he suddenly collapsed and started shaking…
Next thing I remember, I was in the ambulance. My head feels foggy and my arms are weak…
Honestly, I have no memory of what happened — it’s terrifying.”

• Age/Sex: 28-year-old male
• Chief Complaint: Witnessed loss of consciousness with convulsive movements
• Scene: Collapsed suddenly inside a supermarket with jerky limb movements lasting 2–3 minutes. Currently alert but mildly confused.
• Additional Info: Tongue biting noted by paramedics. Past medical history and medication use unknown.

---

🧠 First Impressions – Is It Really a Seizure?

Is it truly a seizure or something else?

A patient suddenly collapsed — but is it a true seizure or just syncope?
This initial distinction is critical. Mistaking one for the other may lead to unnecessary interventions or, worse, missed diagnoses.

In reality, many cases of transient loss of consciousness are not neurologic but cardiovascular in origin — such as vasovagal syncope, orthostatic hypotension, or arrhythmia.

Moreover, myoclonic jerks can occasionally be seen during syncope, especially if there is brief cerebral hypoxia. This can mimic a convulsion and mislead even trained observers.

👀 Eyewitness Testimony Is Invaluable

Since the patient is often unaware or amnestic during the event, obtaining third-party eyewitness information is critical.

• How did the event start?
• Was there any warning (aura, dizziness)?
• What exactly happened during the episode?
• How long did it last?
• What happened after the event?

Even if the witness is a passerby or shop clerk, their account can provide essential diagnostic clues.

🆘 On-Site Emergency Response – What If You Witness a Seizure?

If you encounter someone seizing in a public place, here’s what you should do as a first responder:

1. Ensure safety: Remove dangerous objects (traffic, stairs, sharp edges). Cushion the head with a bag or jacket if available.
2. Observe and record: Note the duration and type of movements. Video recording (if appropriate) can be extremely helpful for diagnosis.
3. Call emergency services: If the seizure lasts more than 5 minutes, shows no sign of recovery, or the person appears seriously unwell, call for an ambulance immediately.

---

🔍 Fact / Problem / Hypothesis – Structuring Your Differential Diagnosis

🧠 Feeling lost? Start with a Structured Approach

You’ve encountered a patient who collapsed, had convulsive movements, and shows post-event confusion — where do you even begin?

This is where the triad of Fact → Problem → Hypothesis becomes your clinical compass.

📌 Fact – What Do We Know?

• 28-year-old male suddenly collapsed while shopping
• Witnesses observed limb jerking lasting about 2–3 minutes
• Tongue biting reported, urinary incontinence unknown
• Postictal confusion and fatigue noted; now alert but disoriented
• No fever, headache, or known preceding symptoms
• No known medical or medication history

🧠 Problem – How Should We Reframe the Situation?

This is a case of acute and transient loss of consciousness with involuntary movements.
At first glance, it appears to be a generalized tonic-clonic seizure.
However, we must not overlook other possibilities: syncope, metabolic disturbance, stroke, intoxication, or even psychogenic episodes.

💡 Hypothesis – What Could This Be?

Use the VITAMIN CDE framework to generate a broad differential:

Category	Example Diagnoses
Vascular	Hemorrhagic stroke, post-stroke epilepsy
Infectious	Encephalitis, meningitis (look for fever, neck stiffness)
Trauma	Head injury, old TBI with seizure focus
Autoimmune / Epilepsy	New-onset epilepsy (e.g. JME), autoimmune encephalitis
Metabolic	Hyponatremia, hypoglycemia, hepatic encephalopathy
Iatrogenic / Intoxication	Psychotropics, antidepressants, alcohol withdrawal
Neoplastic	Brain tumors, metastatic lesions
Congenital	Genetic epilepsy syndromes, cortical dysplasia
Degenerative / Psychogenic	PNES (Psychogenic Non-Epileptic Seizures)
Endocrine / Others	Thyroid dysfunction, stress, sleep deprivation

🎯 What Do We Need to Know Next?

At this point, we need to gather more detailed information to validate or refute our hypotheses.
Here’s what you should look for:

Category	Key Questions / Data
History of Present Illness (HPI)	Triggers, progression, duration, recovery, eyewitness description
Past Medical History (PMH)	Epilepsy, stroke, TBI, CNS infection, psychiatric conditions
Family History (FH)	Epilepsy, sudden death, febrile seizures
Social & Substance Use	Alcohol, drugs, sleep habits, occupational stress
Medications	Antiepileptic drug withdrawal, psychiatric meds, toxins
Physical Exam (next step)	GCS/AVPU, neuro deficits, trauma signs, vitals
Laboratory / Imaging (coming up)	Glucose, Na/Ca/Mg, CK, lactate, head CT, EEG if available

Following the structured path of Fact → Problem → Hypothesis → NTK (Need To Know) brings you one step closer to the true underlying cause of the seizure-like event.

---

🗣️ Step 1: History Taking – “When, What, and How Did It Happen?”

🎯 Use OPQRST to Reconstruct the Event

Asking “What kind of seizure was it?” is often too vague.
Instead, we need to uncover whether it really was a seizure, and whether it might be epileptic in nature.
That’s where the OPQRST framework becomes invaluable.

OPQRST	Key Questions	Clinical Significance
O – Onset	When did it start? Was it sudden or gradual?	Epileptic seizures are typically abrupt; syncope may have prodromes.
P – Provocation	Was there a trigger? (Sleep deprivation, fever, flashing lights?)	Photosensitivity or stress may trigger specific epilepsies.
Q – Quality	What kind of movements? Jerking, stiffening, twitching? Any asymmetry?	Tonic-clonic, focal, or myoclonic? This helps with seizure classification.
R – Region	Where did it start? (e.g., right hand, face, leg)	Focal seizures often begin in one region and spread.
S – Severity	How intense was it? Did anyone witness it?	Eyewitness accounts often provide the most accurate details.
T – Time course	How long did it last? First time? Recurrent?	>5 minutes → status epilepticus; postictal duration is key.

💡 Don’t Forget the Accompanying Features

• Tongue biting: Especially on the side, is highly suggestive of epileptic seizures.
• Urinary incontinence: Seen in both seizures and syncope, but still supportive.
• Postictal confusion: Very characteristic of epilepsy.

🛠️ Quick Phrases You Can Use:

• • “Did anyone see what happened?”

• “Was there any warning before you collapsed?”
• “How long were you unconscious?”
• “Did you feel confused or tired afterward?”
• “Have you ever experienced this before?”

🔍 Use OPQRST Timing and Onset to Differentiate Syncope vs Seizure

Onset: Sudden onset? → Think seizure or cardiac syncope
Gradual onset? → Think vasovagal or orthostatic syncope

Recovery: Quick return to normal? → More likely syncope
Prolonged confusion or lethargy? → Suggestive of seizure

📚 Evidence Corner

In a 2024 study involving 671 patients, a structured symptom questionnaire was able to differentiate seizures from syncope with 94% sensitivity and 94% specificity.
Key features included prolonged post-event confusion, tongue biting, and abrupt onset without warning.

(Snyder E, et al. Epilepsy Behav. 2024 Apr;153:109686)

---

📋 Background Check: PAM HITS FOSS Framework

Now, gather predisposing factors using the PAM HITS FOSS checklist — it helps uncover hidden risks or secondary causes.

Category	What to Ask	Why It Matters
P – Past history	Epilepsy, stroke, trauma, CNS infections	Underlying neurological vulnerabilities
A – Allergies	Any drug-related seizures (e.g. antihistamines, antidepressants)	Possible iatrogenic seizures
M – Medications	Current or discontinued AEDs, psych meds	Withdrawal seizures are common after missed doses
H – Hospitalizations	ICU stays, CNS infections	Consider NCSE or metabolic encephalopathies
I / T – Injury / Trauma	Head injury, past concussions	Can lead to post-traumatic epilepsy
S – Surgery	Any brain or spinal procedures	Scar tissue may act as seizure focus
F – Family history	Epilepsy, sudden death, febrile seizures	Genetic predisposition (e.g. JME)
O – OBGYN	Pregnancy, eclampsia history	Always rule out eclamptic seizures in women
S – Sexual / Social history	Alcohol, drugs, sleep habits, stress levels	Alcohol withdrawal and sleep deprivation are major triggers

Always think beyond the event — the background often holds the answer.

---

🩺 Step 2: Physical Examination – Interpreting the Present State

🎯 Purpose of the Physical Exam in Suspected Seizures

Once the history suggests a possible seizure, the physical exam helps answer three critical questions:

• Was this truly a seizure?
• Is the seizure still ongoing? (e.g., subtle status)
• Are there signs pointing to an underlying cause or complication?

🔍 Head-to-Toe Approach for Post-Seizure Patients

🧠 1. Mental Status – Use GCS or AVPU

Evaluate consciousness immediately. Postictal confusion is common after generalized seizures.

• AVPU: Alert, responds to Voice, Pain, or Unresponsive
• GCS: Eye / Verbal / Motor response – useful for tracking progress

If consciousness is not improving, suspect ongoing seizure activity (e.g., non-convulsive status epilepticus).

👁️ 2. Head and Neck

• Check for trauma – scalp lacerations, hematomas
• Inspect the tongue for lateral bite marks
• Assess for neck stiffness (meningitis or SAH)
• Fundoscopy: signs of papilledema or retinal hemorrhage

👂 3. Ears

Otoscopic exam is important in children to identify otitis media (may trigger febrile seizures).

🧠 4. Neurological Examination

• Todd’s Paralysis: Postictal focal weakness mimicking stroke
• Assess motor strength, cranial nerves, speech, and gait
• Any persistent neurological deficit may suggest stroke or structural lesion

🫁 5. Vital Signs and Cardiopulmonary

• Check for fever → suggests infection
• Check SpO₂, respiratory pattern → assess cerebral perfusion
• Auscultate for arrhythmias or murmurs → consider cardiac syncope

🦵 6. Skin, Limbs, and Trauma

• Look for signs of trauma from falling
• Inspect for cyanosis, incontinence, or peripheral bruising

🚩 Red Flags Not to Miss

• Persistent altered consciousness → consider NCSE
• Neck stiffness + fever → meningitis or encephalitis
• Unilateral weakness or aphasia → stroke or focal lesion

🧠 AVPU vs GCS vs JCS – Choosing the Right Tool

Scale	Features	Best Used In
AVPU	Quick, simple assessment	Prehospital or triage settings
GCS	Detailed scoring (E/V/M)	Head trauma, ICU, neuro monitoring
JCS	Japanese system using numbers	Common in Japanese hospitals

---

🧪 Step 3: Investigations – Confirm the Cause, Prioritize Safety

🔎 Don’t Just Order Everything — Investigate With Purpose

Now that your history and physical exam have formed a working hypothesis, it’s time to select investigations — not blindly, but based on what you want to confirm or rule out.

🚨 First Priority: Rule Out Seizure Mimics That Can Be Fatal

Before labeling the episode as a seizure, eliminate other life-threatening conditions:

• Hypoglycemia: Always check glucose first
• Electrolyte imbalances: Na⁺, Ca²⁺, Mg²⁺ abnormalities can provoke seizures
• Hepatic encephalopathy: Measure ammonia if liver dysfunction suspected
• Alcohol-related causes: Withdrawal, trauma, intoxication
• PNES: Look for inconsistent, prolonged, reactive episodes
• Uremia, DKA, SIADH: Urine tests and serum osmolality help in differentiation

✅ Labs That Support Recent Seizure Activity

• Prolactin: Elevated for 15–60 min post-seizure (not specific)
• Creatine Kinase (CK): Increases due to muscle contractions
• Lactate: Temporary rise following tonic-clonic seizures
• Ammonia: May rise post-seizure or in hepatic dysfunction

🖼 Imaging: Do We Really Need CT or MRI Right Now?

Imaging is not always necessary immediately. Ask yourself:

• Is this the first seizure?
• Was there trauma involved?
• Can the patient be safely transported and remain stable during imaging?

In suspected NCSE (non-convulsive status epilepticus), blindly sending the patient to the CT room may be dangerous.

🧠 EEG – When Should It Be Done?

• Not required emergently for all first-time seizures
• Helpful when:
  • Absence or atypical seizures suspected
  • Postictal confusion persists (NCSE)
  • Recurrent, undiagnosed spells in children
• If unavailable, provide thorough history + physical for specialist referral

🩺 Other Helpful Investigations

• Lumbar puncture: Suspected CNS infection (meningitis, encephalitis)
• ABG: Assess acid-base status, CO₂ retention
• POCUS: Evaluate hydration status, cerebral edema, signs of infection
• ECG: Rule out arrhythmia, QT prolongation, Brugada syndrome
• Toxicology screen: Suspected drug overdose or poisoning

---

🔁 Case Review – Let’s Apply the Steps to Our Patient

Now that we’ve gone through Steps 1–3, let’s revisit the case presented at the beginning.
We’ll apply each step to walk through the diagnostic reasoning process together.

🟦 Step 1: History Taking (Fact → Problem → Hypothesis)

🩺 Doctor: “What brings you in today?”
👨‍🦱 Patient: “I was walking through the store, then everything went black.
Next thing I knew, strangers were around me and I was in an ambulance. My head feels foggy.”

🩺 Thinking: “Sounds like sudden loss of consciousness. A witness said he was jerking before collapsing — time to clarify details using OPQRST.”

✅ OPQRST Summary

• Onset: Sudden collapse while walking
• Progression: Jerking lasted ~2 minutes, full recovery took 5 minutes
• Quality: Tonic stiffening followed by clonic movements
• Radiation: None reported
• Severity: Fell and bit his tongue, minor bleeding noted
• Timing: First-ever episode, no prior history
• Associated Symptoms: Postictal fatigue, confusion

📋 PAM HITS FOSS Summary

• P: No prior seizures or neuro history
• A: No known allergies
• M: Occasionally uses zolpidem (sleep aid)
• H/I/T: No trauma, hospitalizations, or injuries
• S: No past surgeries
• F: Cousin has epilepsy
• O: Not applicable
• S (Social): Irregular sleep, night shifts, drinks socially

🧠 Fact / Problem / Hypothesis

• Fact: Witnessed tonic-clonic movements, tongue biting, postictal confusion
• Problem: Sudden, short-lived episode with typical seizure features
• Hypothesis:
  • First-onset generalized tonic-clonic seizure
  • Metabolic mimic (e.g., hyponatremia, hypoglycemia)
  • PNES
  • Alcohol-related trigger
  • Cardiogenic syncope (e.g., Brugada syndrome)

---

🟦 Step 2: Physical Exam Review

• Mental status: Slight drowsiness (GCS 14), JCS I-2
• Head: Scalp bruise on the left temple, tongue laceration with bleeding
• Neuro exam: No clear focal deficits, but Todd’s paralysis still possible
• Pupils / eyes: Equal, reactive; no nystagmus
• Heart & lungs: Normal heart sounds and breath sounds
• Extremities: No edema or weakness

---

🟦 Step 3: Investigations Review

• Blood glucose: Normal → hypoglycemia ruled out
• Electrolytes: Na 138, Ca 9.2 → normal
• Prolactin: Mildly elevated → supportive evidence
• CK & lactate: Elevated → consistent with tonic-clonic activity
• Ammonia: Mildly elevated → consider liver status
• Head CT: No hemorrhage or mass → structural causes ruled out
• ECG: Normal sinus rhythm, no Brugada pattern, QTc normal

✅ Working Diagnosis:

Likely a first-onset generalized seizure.
No clear secondary cause identified.
Triggers may include sleep deprivation and alcohol.

🩺 “The next step is outpatient EEG and referral to neurology.
In the meantime, I’ll advise on seizure precautions, activity restrictions, and driving limitations.”

---

📨 Referral – When and What to Share with Specialists

🔶 When Should You Refer to a Neurologist?

Not every first-time seizure requires an urgent referral.
However, certain red flags and risk factors warrant early specialist involvement.

🚩 Indications for Referral

• First seizure with unclear cause (e.g., not clearly provoked by hypoglycemia or meds)
• Suspicion of structural brain lesion (e.g., tumor, stroke)
• Persistent focal deficits post-seizure (e.g., Todd’s paralysis)
• Prolonged confusion or behavioral changes (possible NCSE)
• Children or elderly with possible CNS infection or encephalitis
• Recurrent seizures with poor control or unclear etiology

✅ What to Prepare Before Referral

Specialists will appreciate concise yet comprehensive documentation. Prepare the following:

🧪 Item	🔍 Details	💡 Why It’s Helpful
Head CT (non-contrast)	Exclude bleeding, tumor, mass effect	Essential in all first seizures with trauma
Blood tests	Na⁺, glucose, calcium, ammonia, CK	Rule out reversible mimics
ECG	Check for arrhythmias, QT prolongation, Brugada	Exclude cardiac syncope
EEG (if available)	Assess for epileptiform discharges	Useful in focal or absence-type seizures
Social & lifestyle factors	Sleep, stress, alcohol, night shifts	Identify preventable triggers
Family history	Epilepsy, febrile seizures, sudden death	Support genetic syndromes (e.g., JME)

🧠 Risk of Recurrence – Should We Be Worried?

Even a single seizure can carry a high risk of recurrence, depending on context.
Studies and guidelines (ILAE, STABLE score) highlight the following recurrence predictors:

• Structural brain abnormalities (e.g., post-stroke, trauma)
• Epileptiform discharges on EEG
• Seizures during sleep or early morning
• Family history of epilepsy or febrile seizures

🗣️ How to Present the Case – Sample Summary for Neurology Referral

“This is a 30-year-old male who experienced his first tonic-clonic seizure.
There were no clear provoking factors.
Head CT and labs ruled out secondary causes.
I would appreciate your evaluation for epilepsy and long-term management planning.”

---

🧠 Tips – Interview & Exam Tricks for Seizure Evaluation

🔍 Interview Tips – Ask What Matters Most

🕰️ “Was it sudden? Did they recover quickly?”

How the event started and how the patient recovered gives crucial clues:

• “Did it come on suddenly, or did you feel lightheaded before?”
• “How long did it take before you felt normal again?”

👁️ When There’s No Witness – What Should You Ask?

If no one observed the event, gather indirect clues:

• “Did you injure yourself when you fell?”
• “Was your tongue bitten or bleeding?”
• “Was your phone or bag on the ground?”

💊 Sleep, Meds, and Alcohol – Don’t Hesitate to Ask Directly

• “How has your sleep been recently?”
• “Any missed doses of your usual meds?”
• “Did you drink any alcohol last night?”

---

🩺 Physical Exam Tips – Look Closely, Think Broadly

👅 Always Check the Mouth and Head

• Inspect for tongue lacerations (especially on the side)
• Look for bruising or wounds from falls

💪 Todd’s Paralysis – Don’t Confuse with Stroke

• • Unilateral weakness after a seizure may mimic stroke
  • Ask: “Can they grip? Can they lift both arms?”
  • Note: Todd’s paresis usually resolves within hours

🧠 Want to explore more about different types of paralysis?
👉 Check our article on how to approach paralysis (palsy): causes, exam tips, and differential diagnosis

🌡️ Fever + Altered Mental Status – Always Rule Out Infection

• Check for neck stiffness, photophobia
• Think meningitis or encephalitis if mental status remains low

---

🛠️ Additional Tips for Bedside Assessment

🧠 Consciousness – Use the Right Scale for the Setting

Scale	Strength	Best Use
AVPU	Fast & simple	ER triage, prehospital
GCS	Tracks changes numerically	Head trauma, ICU
JCS	Common in Japan	Standard charting

🦷 Easy-to-Miss Findings That Help the Diagnosis

• Ear lacerations → fall-related trauma
• Tongue injury → supports true seizure
• Confused speech or drowsiness → think postictal state

---

💬 Clinical Pearls

“Not everything that shakes is a seizure, and not every seizure shakes.”
— Epilepsy Foundation

This quote reminds us that:

• Just because a patient exhibits convulsive movements doesn’t mean it’s a seizure (e.g., syncope with myoclonic jerks)
• And not all seizures are convulsive — some are subtle, like absence seizures or NCSE (non-convulsive status epilepticus)

In both OSCE and real clinical settings, this perspective helps prevent misdiagnosis of seizure mimics, and ensures that “quiet” seizures are not overlooked.

---

🗣️ OET Speaking Session – Seizure (First-Time Episode)

👥 Scenario

You are a general practitioner. A 28-year-old man presents following an episode of collapse with limb shaking and temporary confusion.
He has no prior history of seizures. A bystander reported convulsive movements lasting approximately 2 minutes, and the patient appears mildly confused but is now alert.

You suspect a first-onset generalized seizure, but mimics (e.g., syncope, metabolic causes) have not been excluded.

🎯 Your Task

• Explain what likely happened and what a seizure is
• Discuss possible causes and the need for investigations
• Reassure the patient and address emotional concerns
• Provide clear next steps, including driving restrictions and referral

💬 Sample Statements for Your Task

• Explanation: “Based on what you and the witness described, it seems likely that you experienced a seizure.”
• Cause & Plan: “Seizures can sometimes happen once and never again, but we’ll run some tests to rule out anything serious.”
• Education: “Not all seizures mean epilepsy. We need more information before we can make a diagnosis.”
• Driving Advice: “In most countries, driving is restricted for a period after a seizure — usually six months — to ensure your safety and that of others.”

💬 Common Patient Cues & Sample Doctor Responses

🧠 Challenging Questions & Sample Doctor Responses

✉️ OET Writing Task – Sample Referral Letter

Today’s Date

Dr. Natalie Wong
Neurology Department
City Medical Hospital

Re: Mr. Joshua Bennett, 28 years old

Dear Dr. Wong,

I am referring Mr. Joshua Bennett, a 28-year-old man, for assessment following a likely first-onset generalized seizure.

Mr. Bennett collapsed at a supermarket and was observed to have tonic-clonic movements lasting approximately 2 minutes. He bit his tongue and was briefly confused post-episode. There was no reported fever, trauma, or prior similar episodes. He has no known history of epilepsy, but his cousin was diagnosed with the condition. He occasionally uses zolpidem and reports recent sleep deprivation and alcohol intake.

On examination, he was alert but mildly drowsy (GCS 14). He had a scalp bruise and lateral tongue injury but no focal neurological deficits. Blood tests including glucose, sodium, and calcium were within normal limits. CK and lactate were elevated. CT brain was unremarkable. ECG showed normal sinus rhythm. EEG is pending but not yet available in our facility.

I would appreciate your expert evaluation regarding further investigations, long-term seizure risk, and potential need for anti-epileptic therapy.

Please let me know if further details are required.

Yours sincerely,

Dr. [Your Name]
General Practitioner

---

📝 Summary – Seizure Evaluation: What We’ve Learned

In this article, we explored the structured approach to evaluating a patient with seizure-like activity — from the first moment in the ED or clinic, through diagnosis, and onward to specialist referral.

🧠 Key Takeaways

• Not every collapse with jerking is a seizure: Consider mimics like syncope, PNES, or metabolic derangements.
• Seizure ≠ epilepsy: A single seizure doesn’t confirm epilepsy. Think in terms of recurrence risk, context, and investigations.
• History and witnesses matter more than tests: Eyewitness accounts, OPQRST, and PAM HITS FOSS often guide diagnosis more effectively than labs.
• EEG and imaging are helpful, but not always emergent: CT is useful to rule out dangerous causes. EEG is important for follow-up, not always in the ED.
• Postictal confusion, tongue biting, and Todd’s paralysis are classic signs that support true epileptic seizures.
• Driving restrictions, safety planning, and patient education are essential after a first seizure — even if no treatment is started yet.

Ultimately, diagnosing seizures is not just about identifying an event — it’s about understanding what caused it, how to prevent recurrence, and how to support the patient in daily life.

As a family physician or generalist, your role doesn’t end with the first consultation. Helping patients navigate uncertainty, reduce risk, and regain control of their lives after a seizure is where continuity of care truly matters.

---

🔗 Related Articles

• 🌡️ Fever Evaluation – Is it really “just a cold”?
• 💓 Chest Pain Diagnosis – History, Physical Exam & POCUS
• 🧍‍♂️ Syncope & TLOC – How to Approach Transient Loss of Consciousness
• 💤 Fatigue and General Malaise – Diagnosing the Hidden Causes

🗾 日本語で読みたい方はこちら：
👉 けいれんの診かた｜日本語版はこちら

---

📚 References

1. Epilepsy Foundation. https://www.epilepsy.com/
2. Fisher RS, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy. Epilepsia. 2005 Apr;46(4):470–472.
3. National Institute for Health and Care Excellence (NICE). Epilepsies: diagnosis and management. NICE guideline [NG217]. 2022.
   https://www.nice.org.uk/guidance/ng217
4. Hashimoto K, et al. Diagnostic value of “sudden onset and quick recovery” in differentiating syncope from seizure. J Gen Intern Med. 2023;38(1):123–129.
5. Snyder E, et al. Clinical accuracy of seizure vs syncope differentiation by symptom questionnaire. Epilepsy Behav. 2024 Apr;153:109686.

---