A first presentation with a witnessed convulsion is often not the first seizure. Earlier events may have been unwitnessed nocturnal seizures, focal impaired-awareness seizures mistaken for blackouts, or falls without a clear trip.
Asking directly about previous unexplained falls, waking with a bitten tongue, unexplained bruising, incontinence at night or lost time changes the classification. Two or more unprovoked seizures make a diagnosis of epilepsy and alter decisions about treatment and driving.
- Ask about previous unexplained falls, blackouts or injuries in anyone presenting with a first seizure.
- Ask about waking with a bitten tongue, muscle aches or wet bed.
- Seek a witness account by phone if no one came with the patient.
- Reclassify as epilepsy when earlier events fit unprovoked seizures, and advise on driving accordingly.
Why it matters
Missed earlier events lead to undertreatment and wrong driving advice.
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