Determining Seizure Types and Epilepsy Syndromes

Even if it is clear on clinical grounds that the symptoms of interest are actually epileptic seizures, it is important to determine the type or types of seizures a patient has. Characterization of ictal and interictal abnormalities can help to determine seizure types and epilepsy syndromes, in conjunction with other clinical features and family history. Even with an accurate diagnosis of epilepsy, it is often appropriate to determine whether new, additional, or different behavioral episodes are seizures or not—there could be both seizures and PNES. This may become pertinent when a patient's seizures are poorly controlled; it may be asked whether the original diagnosis is correct.

The EEG recorded at the time of an event can help in seizure and epilepsy classification. It is commonly difficult to determine clinically whether a patient has a primary generalized or focal (localization-related) epilepsy. The recording of generalized spike-wave discharges or focal abnormalities obtained interictally or, better, during seizures, can help to make this distinction. For example, a young adult may have staring spells that are clearly epileptic in origin, but the treatment and prognosis may differ depending on whether the spells are primary generalized "absence" seizures or focal-onset complex partial seizures.

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