Apart from listening carefully to the story given by the person and any eyewitness, what else will the doctor do?

She will examine her patient not only to make sure that everything is generally well-for example, that breathing is unobstructed—but she will also ascertain if there are any focal (localized) neurological signs, which may give her a clue to the cause of the seizure. Though she is not likely to find anything abnormal at this stage, there may be some minor signs such as an asymmetry of the reflexes. She will then question the relatives or other witnesses, and satisfy herself that what has just occurred was indeed a seizure, and not some other event of the type discussed later in this chapter. Rarely, the first seizure is an early manifestation of an acute and important illness such as meningitis or encephalitis. If she suspects that this might be the case, she will of course arrange immediate admission to hospital. More often, all that is necessary is for her to give a tablet or injection of diazepam (Valium), which is sufficient to raise the seizure threshold and make a second seizure less likely for some hours. This will give everyone time to collect their thoughts and decide on the long-term policy decisions, including the possible needs for referral to a specialist, for investigation, and for institution of anti-epileptic treatment.


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