Seizure physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Physical Examination
Vital Signs
Many seizures, especially in children, are preceded by tachycardia that frequently persists throughout the seizure. This early increase in heart rate may supplement an aura as a physiological warning sign of an imminent seizure.
Overview
The physical examination of patients with seizure may reveal: lateral tongue bites, nuchal rigidity or asterixis, bruises or scrapes on the body after falls, signs of a neurocutaneous syndrome associated with epilepsy on the skin, back pain, and transient or persistent focal weakness or asymmetry.
Physical Examination
The physical examination of patients with seizure may reveal:[1][2][3][4]
- Lateral tongue bites
- Observed in 22% of patients with all types of epileptic seizures, but not observed in patients with psychogenic nonepileptic seizures.
- A small study found that finding a bite to the side of the tongue was very helpful when present in diagnosing seizure.[5]
- Sensitivity of 24%
- Specificity of 99%
- Nuchal rigidity or asterixis
- May suggest an underlying systemic disorder
- Bruises or scrapes on the body after falls
- Signs of a neurocutaneous syndrome associated with epilepsy on the skin (such as neurofibromatosis, tuberous sclerosis, and Sturge-Weber syndrome)
- Back pain
- May suggest a vertebral compression fracture
- Transient or persistent focal weakness or asymmetry
- May suggest the area of the brain abnormality that may have caused the seizure
References
- ↑ Gavvala JR, Schuele SU (2016). "New-Onset Seizure in Adults and Adolescents: A Review". JAMA. 316 (24): 2657–2668. doi:10.1001/jama.2016.18625. PMID 28027373.
- ↑ Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG; et al. (2012). "Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective". Epilepsy Behav. 25 (2): 251–5. doi:10.1016/j.yebeh.2012.06.020. PMID 23041172.
- ↑ Browne TR, Holmes GL (2001). "Epilepsy". N Engl J Med. 344 (15): 1145–51. doi:10.1056/NEJM200104123441507. PMID 11297707.
- ↑ Ahmed SN, Spencer SS (2004). "An approach to the evaluation of a patient for seizures and epilepsy". WMJ. 103 (1): 49–55. PMID 15101468.
- ↑ Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F (1995). "Value of tongue biting in the diagnosis of seizures". Arch. Intern. Med. 155 (21): 2346–9. PMID 7487261.