Diagnosis

The diagnosis of epilepsy is clinical, depending on the history from the patient and, critically, from any witnesses of the attacks. This can be supported by investigations such as an EEG, but the main contribution of the EEG is in syndrome classification. The differential diagnosis of blackouts is discussed on page 44.

Classification of seizures and epilepsy syndromes

Much of the confusion about the classifications in epilepsy arise because of a failure to appreciate that there are two interrelated classifications: a classification of seizure type (Fig. 1) and a classification of epilepsy syndromes (Table 1). Patients may have more than one type of seizure. The epilepsy syndrome includes diagnosis of seizure type and additional information, mostly relating to aetiology, including age, EEG and neuroimaging results. Where possible, patients’ epilepsy should be classified by epilepsy syndrome rather than seizure type, which takes into account these other factors. The old terms ‘petit mal’ and ‘grand mal’ do not fit easily into this classification and should not be used.

Fig. 1 Seizure types in focal and generalized epilepsies. Some seizure types occur only in focal or in generalized epilepsies but many can occur in both types and cannot easily be classified purely on the basis of clinical seizure type.

Table 1 Some of the more common epilepsy syndromes (all generalized, except BECTS)

There are three broad categories of epilepsy syndromes:

Patients who have had only a few attacks may not be classifiable into an epileptic syndrome.

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