The Role of Medical History and Physical Exams

Reviewed by: HU Medical Review Board | Last reviewed: November 2021

Epilepsy is a neurological (brain) disease that causes people to have seizures. But people may have seizures for many reasons, not just epilepsy. A physical exam and detailed medical history will help your doctor correctly diagnose you.

Generally, a person is diagnosed with epilepsy if they have at least 2 unprovoked seizures more than 24 hours apart. "Unprovoked" means the seizure was not caused by a medical condition other than epilepsy. The physical exam and medical history help your doctor rule out other health issues that may mimic epilepsy.1,2

Physical exam

A physical exam includes weighing you and checking your blood pressure. The doctor will also check the other organ systems in your body. This includes looking in your eyes and ears, tapping on certain areas, and listening to your heart and breathing.1,2

This gives the doctor basic information about your overall health. After the physical exam, your doctor may conduct a neurologic exam. A neurological exam is a detailed and specialized physical exam performed by a neurologist. This checks your brain and nerve function.1,2

While your doctor will be the person taking note of your health history and performing the exam, you play an important role in this process.

An accurate, detailed description of symptoms

Be ready to describe your medical history in detail and as accurately as possible. Come with a list of the medicines and supplements you take, and any surgeries and illnesses you have had. This helps your doctor get all the information needed to diagnose and treat your seizures. This may not be easy, but taking notes ahead of time can help you remember.

Questions your doctor may ask you include:1,2

  • When did these attacks start?
  • What were you doing when the seizure started?
  • How often do you have these symptoms?
  • How intense are your symptoms?
  • How long do the symptoms last?
  • Do you notice changes in your smell, taste, vision, or hearing before a seizure?
  • Do you have to stop normal activities like working, cooking, or walking?
  • Does anyone else in your family have seizures?
  • Is there a family history of epilepsy?
  • Do you have a history of head injury from an accident or sports?
  • How much do you drink?
  • Do you use any prescription, over-the-counter, or recreational drugs?
  • How is your sleep?
  • How is your stress level?

You may also be asked about your work, hobbies, and exercise habits.

Screening tools

Along with talking with you, your doctor may conduct several tests. The results of these tests will help rule out other conditions like migraine, brain tumor, stroke, sleep disorders, infection, diabetes, or panic attack. These tests include:1,2

  • EEG (electroencephalogram)
  • MRI (magnetic resonance imaging)
  • CT scan (computed tomography)
  • Neurological exam
  • Blood work
  • Urinalysis
  • Spinal tap (lumbar puncture)
  • Genetic testing

Using a seizure diary for diagnosis

Keeping a seizure diary (sometimes called a seizure journal) will also help you and your doctor find answers. If you are not aware during your seizures, ask another person video the event on their phone.3

A seizure diary should include:3

  • Day and time of seizure
  • How long the seizure lasted
  • Symptoms like shaking, consciousness, staring, lip-smacking, fidgeting, and falls
  • Whether you were injured during the seizure
  • Whether you had bowel/bladder incontinence
  • Any post-seizure symptoms such as fatigue or confusion
  • How long it takes to feel normal again
  • If you notice any patterns in your seizures or any triggers

A seizure diary can be as simple as a notebook or more advanced, like an app on your phone. It should be easy for you to use and easy for another person to use if you lose consciousness. It should also be easy to share the information with your doctor.

The Epilepsy Foundation lists several seizure diary types you can try.

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