First seizures in adults

Author's reply to Girling

“…1 In my article, only the most common causes of symptomatic seizure could be mentioned. 2 Eclampsia is a rare cause of symptomatic first seizure (structural/metabolic seizure in the new terminology). 3 4 Many other rare causes were also not discussed, such as autoimmune disorders, which again have a unique management pathway.…”

Bias in counseling of seizure patients following a transient impairment of consciousness: Differential adherence to driver fitness guidelines

“…M a n u s c r i p t 7 The study was approved by the University of Alberta research ethics board. Written consent was waived by the board.…”

“…As such, patients with epileptic seizures are frequently counseled against driving by their physician because of safety concerns (4). A sudden and unexpected transient impairment of consciousness, however, can also occur in several conditions that mimic seizures (e.g., syncope, psychogenic seizures, hypoglycemia, sleep attacks), and it has been estimated that these are 3-10 times more prevalent than are seizures (5,6,7). The onus, therefore, falls squarely on physicians to evaluate driver fitness for a great number of patients, and to counsel against driving notwithstanding the potential impact upon patients' quality of life (8).…”

Evaluation of the first seizure patient: Key points in the history and physical examination

“…The first seizure evaluation should include an inquiry into signs suggestive of nocturnal seizures, such as waking in the morning to find a bitten tongue, blood on the pillow, urinary incontinence, or other unexplained injuries [35]. Evidence of non-convulsive seizures should be sought by asking about spells of unresponsiveness, myoclonic jerks, or stereotyped sensory experiences suggestive of auras.…”