Seizure physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D.  Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD
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, transient or persistent focal weakness or asymmetry, and urinary incontinence.
The physical examination of patients with seizure may reveal:
Appearance of the Patient
- Patients with seizure may appear completely normal or may have signs of trauma or other findings specific to the underlying etiology.
- Vital signs are usually normal once baseline is reached. However, it should be monitored.
- Oxygen saturation should be assessed.
- Skin examination of patients with seizure is usually normal. There may be bruises or scrapes on the body after a fall due to seizure.
- Signs of a neurocutaneous syndrome associated with epilepsy on the skin (such as neurofibromatosis, tuberous sclerosis, and Sturge-Weber syndrome) may be observed.
- 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.
- Sensitivity of 24%
- Specificity of 99%
- Nuchal rigidity or asterixis: May suggest an underlying systemic disorder
- Pulmonary examination of patients with seizure is usually normal.
- Cardiovascular examination of patients with seizure is usually normal.
- Abdominal examination of patients with seizure is usually normal.
- Back examination of patients with seizure is usually normal. Some patients may complain of back pain, it may suggest a vertebral compression fracture
- Genitourinary examination of patients with seizure is usually normal. Patient may have had urinary incontinence during the episode.
- Neuromuscular examination of patients with seizure should include assessment of orientation to persons, place, and time and altered mental status.
- Transient or persistent focal weakness or asymmetry. May suggest abnormality in the area of the brain affected.
- Extremities examination of patients with seizure may show signs of trauma due to fall.
- ↑ 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.
- ↑ Bank AM, Bazil CW (2019). "Emergency Management of Epilepsy and Seizures". Semin Neurol. 39 (1): 73–81. doi:10.1055/s-0038-1677008. PMID 30743294.
- ↑ 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.