Epilepsy physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Fahimeh Shojaei, M.D.

## Overview

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Common physical examination findings of epileptic seizure include: Automatic behaviors, upward eye rolling, unconsciousness, drooling, cyanosis, post-ictal drowsiness, fever, tachycardia, hypertension, mydriasis, nystagmus, urine and fecal incontinence, disorientation to persons, place, and time, altered mental status, automatic behaviors (repetitive muscle movement), Muscle rigidity and hyper-reflexia.

## Physical Examination

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Physical examination of patients with epilepsy is usually remarkable for:

### Appearance of the Patient

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* Patients with epilepsy usually appear normal between the seizures.
* During an epileptic seizure, based on seizure type they present with signs such as:
* Automatic behaviors
* Upward eye rolling
* Unconsciousness
* Drooling
* Cyanosis
* After an epileptic seizure, based on seizure type the can present with signs such as drowsiness and confusion or no sign at all.[1]

### Vital Signs

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* Fever may be present during the seizure or in the post-ictal phase.
* Tachycardia is present during the seizure and sometimes continue to be high in post-ictal phase.
* Hypertension may be present during the seizure which mostly come back to normal value few minutes after seizure.[2]

### Skin

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* Cyanosis
* Bruises (result of sudden falls or loss of consciousness)[3]

### HEENT

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* Based on the etiology of epilepsy, physical examination of HEENT can be remarkable for:
* Evidence of trauma[4]
* Mydriasis[5]
* Nystagmus[6]
* Icteric sclera[7]

### Neck

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* Neck examination of patients with epilepsy is usually normal.

### Lungs

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* Pulmonary examination of patients with epilepsy is usually normal but they are in increased risk of aspiration and sometimes can present with sign and symptoms of recurrent pneumonia such as:[8][9]
* Physical signs
* Respiration rate >20/min
* Percussion dullness
* Auscultation abnormality
* Bronchial breathing
* Crackles
* Temperature

### Heart

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* Tachycardia before, during and after seizure[10]

### Abdomen

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* Abdominal examination of patients with epilepsy is usually normal.

### Back

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* Back examination of patients with epilepsy is usually normal.

### Genitourinary

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* Urine and fecal incontinence may be present during a seizure attack.[11]

### Neuromuscular

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* Neuromuscular examination of patients with epilepsy is usually normal.
* During a seizure attack:
* Patient is usually disoriented to persons, place, and time.
* Altered mental status
* Automatic behaviors (repetitive muscle movement).[1]
* Muscle rigidity
* Hyper-reflexia can occur in stroke induced epilepsy patients.[12]

### Extremities

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* Extremities examination of patients with epilepsy is usually normal.

## References

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1. ↑ 1.0 1.1 Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
2. ↑ Hampel KG, Jahanbekam A, Elger CE, Surges R (October 2016). "Seizure-related modulation of systemic arterial blood pressure in focal epilepsy". Epilepsia. 57 (10): 1709–1718. doi:10.1111/epi.13504. PMID 27549906.
3. ↑ Hoefnagels WA, Padberg GW, Overweg J, van der Velde EA, Roos RA (February 1991). "Transient loss of consciousness: the value of the history for distinguishing seizure from syncope". J. Neurol. 238 (1): 39–43. PMID 2030371.
4. ↑ Annegers JF, Coan SP (October 2000). "The risks of epilepsy after traumatic brain injury". Seizure. 9 (7): 453–7. doi:10.1053/seiz.2000.0458. PMID 11034867.
5. ↑ Gadoth N, Margalith D, Bechar M (1981). "Unilateral pupillary dilatation during focal seizures". J. Neurol. 225 (3): 227–30. PMID 6167689.
6. ↑ Ma Y, Wang J, Li D, Lang S (2015). "Two types of isolated epileptic nystagmus: case report". Int J Clin Exp Med. 8 (8): 13500–7. PMC 4612972. PMID 26550287.
7. ↑ Mokhtarifar A, Mozaffari H, Afshari R, Goshayeshi L, Akavan Rezayat K, Ghaffarzadegan K, Sheikhian M, Rajabzadeh F (2013). "Cholestasis and seizure due to lead toxicity: a case report". Hepat Mon. 13 (11): e12427. doi:10.5812/hepatmon.12427. PMC 3860072. PMID 24348646.
8. ↑ Hopstaken RM, Muris JW, Knottnerus JA, Kester AD, Rinkens PE, Dinant GJ (May 2003). "Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection". Br J Gen Pract. 53 (490): 358–64. PMID 12830562.
9. ↑ DeToledo JC, Lowe MR, Gonzalez J, Haddad H (August 2004). "Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients". Epilepsy Behav. 5 (4): 593–5. doi:10.1016/j.yebeh.2004.03.009. PMID 15256199.
10. ↑ Behbahani S (July 2018). "A review of significant research on epileptic seizure detection and prediction using heart rate variability". Turk Kardiyol Dern Ars. 46 (5): 414–421. doi:10.5543/tkda.2018.64928. PMID 30024401.
11. ↑ Brigo F, Nardone R, Ausserer H, Storti M, Tezzon F, Manganotti P, Bongiovanni LG (March 2013). "The diagnostic value of urinary incontinence in the differential diagnosis of seizures". Seizure. 22 (2): 85–90. doi:10.1016/j.seizure.2012.10.011. PMID 23142708.
12. ↑ Olsen, T. S.; Hogenhaven, H.; Thage, O. (1987). "Epilepsy after stroke". Neurology. 37 (7): 1209–1209. doi:10.1212/WNL.37.7.1209. ISSN 0028-3878.

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