Epilepsy is the occurrence of two or more seizures that are not provoked by reversible causes such as very low blood sugar or a fever. Epilepsy means that there is a tendency to have recurrent seizures. A detailed and accurate history of a child's seizure-like episodes is the most helpful tool for making the diagnosis of epilepsy. The doctor will want to know how the episode began and what happened:

• Did the spell occur while the child was asleep or awake?
• Did it begin suddenly, shortly after standing, or after an argument?
• Did the child's behavior indicate that he or she may have had a warning (for example, coming to Mom in the kitchen immediately before it started)?
• Was the child well before the spell? Was he or she taking any medicine?
• Did the child have any injuries from the event, such as from falling or biting the tongue?
• Was consciousness lost or impaired?
• Were there jerking movements, automatic chewing or hand movements, eye deviation or blinking, or loss of bladder control?
• Afterward, did the child go to sleep? Or act confused?
• How long did the episode last? (It is best to time an episode with a watch, as 1 minute may seem like 5 minutes to a worried observer.)
• After the spell was over, did the child have any memory of it?
• Has anyone else in the family had similar spells?

If possible, the family should make a video recording of an episode for the doctor to view. All of this information will help the doctor to determine if the episode is a seizure, and if so, what type.

Obtaining an accurate description of symptoms that a child experiences during a seizure is an art. Only the person who feels them can accurately describe them, though in some cases they are easy to identify. For example, the child whose face is suddenly filled with fright and who holds her belly and then begins to stare is most likely experiencing a partial seizure with an emotion of fear and abdominal discomfort. In many children, however, the symptoms cannot be read from behavioral features, and one must rely on the child's report. Many children fail to report what they feel because of shyness, embarrassment, inability to put their feelings into words, inability to recognize the relationship of the symptom to a seizure, inability to recall the event, and other less obvious reasons. If simply asked what he or she experiences, such a child may just shrug. When given a choice of possible symptoms, however, the child will often say that one or more occurred before the seizure. The challenge is then separating true from imaginary symptoms. Therefore, all children who are willing or able to talk about their symptoms should first be asked in a nonthreatening way if they feel anything before or during the spell, or if they ever have sudden, strange feelings separate from it (which could possibly be a simple partial seizure). If they answer no, then they can be asked about specific types of symptoms.

Topic Editor:James W. Wheless, M.D.
Last Reviewed:10/5/06