Diagnosis

Determining a correct and accurate diagnosis is essential prior to any consideration of pharmacotherapy. When a patient complains of paroxysmal, stereotypical spells that may be seizures, it must be determined if the spells are really seizures. Numerous other disorders, including convulsions, syncope, psychogenic nonepileptic events (i.e., pseudoseizures), anxiety attacks, cardiac arrhythmias, hypoglycemia, transient ischemic attacks, tics, and complicated migraine headaches, are often mistaken as seizures by patients and caregivers. Seizures are typically brief spells, lasting no more than 5 minutes. However, seizures can be prolonged and can last for 15 minutes or more. In this situation the patient is in status epilepticus and requires immediate medical attention.

A proper diagnostic workup of a patient presenting with seizures should include the following elements:

• Thorough neurologic examination

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