"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've had what appears to be a seizure. Is that right?"
"Before we go any further, what are your thoughts about what might have caused this, or what it might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today, perhaps a diagnosis or advice?"
"Could you please tell me about what happened leading up to the event? Were there any triggers you noticed, like flashing lights, lack of sleep, stress, or if you've been unwell recently? Did you experience any unusual sensations, smells, tastes, or visual changes before it happened – sometimes people call this an 'aura'?"
"Some events that look like seizures can have different causes. Did you have any symptoms that might suggest fainting, like chest pain, feeling lightheaded before you fell, or did it happen when you quickly stood up?"
"What about other things that might look like a seizure? Did you have shaking due to a fever (rigors)? Or temporary weakness, numbness, or speech problems like a mini-stroke (TIA)?"
"It's really important to get a clear picture of the event itself. Was anyone with you when it happened? If so, would it be okay for me to speak with them later to get their perspective? What did they observe? Were you alert or unresponsive? Can you describe any movements you had – were your limbs stiffening, jerking, or did you do any automatic actions like lip-smacking or fiddling with clothes? Were the movements on one side of your body or both?"
"Did you bite your tongue during the event? If so, was it on the side of your tongue, or just the tip? Did you lose control of your bladder or bowels? Did your skin turn blue or very pale?"
"How long do you think the seizure lasted? Was any medication given to stop it, like a rescue medication?"
"After the seizure stopped, how long did it take you to fully recover and feel completely normal again? Were you confused or drowsy? Did you have a headache, muscle aches, or any weakness on one side of your body (Todd's paresis)?"
"Did you sustain any injuries during the episode, like a head injury, fractures, or cuts?"
"Have you had any similar episodes or seizures before? If so, how many, and how often do they occur? What were the circumstances of those episodes, and were they similar to this one? Have you ever been diagnosed with epilepsy?"
"Do you have any existing medical conditions? I'm particularly interested if you have been diagnosed with epilepsy. If so, can you tell me about your typical seizure patterns, if there have been any changes in your recent seizures, and when your last seizure was?"
"If you have epilepsy, are there any known triggers that lower your seizure threshold, such as stress, lack of sleep, or alcohol consumption?"
"Do you have any other conditions that might be associated with loss of consciousness or seizures, such as a history of head trauma, stroke, a brain tumor, meningitis or encephalitis, eclampsia (if pregnant), alcohol withdrawal, drug overdose, or metabolic issues like low blood sugar or low sodium levels? What about conditions like postural hypotension or heart rhythm problems?"
"Have you ever had any operations or procedures, especially any brain surgery?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? If you have epilepsy, are you taking your antiepileptic drugs regularly? Have you missed any doses recently, or had a dose changed?"
"Have there been any recent changes to your medications – perhaps a new one started, one stopped, or a dose changed? Some medications, including certain antidepressants and antipsychotics, or even illicit drugs like stimulants, can lower the seizure threshold."
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you had?"
"Does anyone in your close family – like your parents, siblings, or children – have a history of epilepsy or febrile convulsions (seizures with fever)? What about any inherited neurological conditions, or cases of sudden unexplained death (SUDEP)?"
"Could you tell me a little about your living situation and who you live with? Do you have a good support network around you? Are you able to manage all your daily activities independently? How have these events impacted your daily life, your education, or your employment?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week, and do you ever binge drink? Do you use any recreational drugs? What are your typical sleep patterns like? How do you manage stress?"
"What kind of work do you do? Does your job involve any high-risk activities, like operating machinery or working at heights?"
"Regarding driving, it's very important that we discuss the implications of this event. You are legally required to inform the DVLA (or your local licensing authority) about any seizure. You will also need to refrain from driving for a certain period, which depends on the type of seizure and whether you have a previous diagnosis of epilepsy."
"Thank you very much for sharing all of that information with me. Just to summarise, you experienced [recap key details of seizure episode], with [recap prodromal symptoms, movements, duration, key features]. This has impacted you by [recap injuries, concerns]. You've also mentioned [recap relevant PMH/DH/FH/SH]."
"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"
"Based on what you've told me, the next steps would be for me to perform a physical examination, focusing on your neurological system, and checking your vital signs. We would also likely arrange for some investigations, such as blood tests (like a full blood count, kidney and liver function tests, glucose, calcium, magnesium, and antiepileptic drug levels if you're on them). We might also do imaging like a CT scan or MRI of your brain, an EEG (brain wave test), or an ECG (heart tracing). We may also refer you to a neurologist or an epilepsy specialist nurse for further assessment and management."
"If it's appropriate, we can arrange for an epilepsy specialist nurse to contact you directly for ongoing support, education, and to help you navigate the practical aspects of living with epilepsy."
"Do you have any questions for me at this stage?"
"Thank you for your time."