title: Evaluation of the first seizure patient: Key points in the history and physical examination.
abstract: OBJECTIVE
  This review will present the history and physical examination as the launching point of the first seizure evaluation, from the initial characterization of the event, to the exclusion of alternative diagnoses, and then to the determination of specific acute or remote causes. Clinical features that may distinguish seizures from alternative diagnoses are discussed in detail, followed by a discussion of acute and remote first seizure etiologies.
  
  
  METHODS
  This review article is based on a discretionary selection of English language articles retrieved by a literature search in the PubMed database, and the authors' clinical experience.
  
  
  RESULTS
  The first seizure is a dramatic event with often profound implications for patients and family members. The initial clinical evaluation focuses on an accurate description of the spell to confirm the diagnosis, along with careful scrutiny for previously unrecognized seizures that would change the diagnosis more definitively to one of epilepsy. The first seizure evaluation rests primarily on the clinical history, and to a lesser extent, the physical examination.
  
  
  CONCLUSIONS
  Even in the era of digital EEG recording and neuroimaging, the initial clinical evaluation remains essential for the diagnosis, treatment, and prognostication of the first seizure.
authors.affiliation: Division of Neurology, Department of Medicine, University of Alberta, 7th Floor Clinical Sciences Building, 11350 83 Avenue NW, Edmonton, Alberta T6G 2G3, Canada. Electronic address: tnowacki@ualberta.ca.
authors.forename: Tomasz A
authors.initials: TA
authors.lastname: Nowacki
authors.affiliation: Division of Neurology, Department of Medicine, University of Alberta, 7th Floor Clinical Sciences Building, 11350 83 Avenue NW, Edmonton, Alberta T6G 2G3, Canada.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Jirsch
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D011379:Prognosis; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology
keywords: Diagnosis; Epilepsy/diagnosis; Medical history taking; Physical examination; Seizures/diagnosis; Syncope/diagnosis