Epilepsy: diagnosis, classification and management

Careful clinical evaluation differentiates epileptic seizures from syncope (vasovagal and cardiogenic), dissociative seizures (non-epileptic attack disorder) and other rarer causes of paroxysmal events. The initial diagnosis of epilepsy is incorrect in 20–30% of patients. Investigations can include blood tests, electrocardiograms, electroencephalograms and neuro-imaging. Patients should be informed and counselled about the diagnosis. Anti-epileptic drugs are the first-line treatment for epilepsy, the choice depending on the epilepsy syndrome, the seizure type, the patient and their co-morbidities.