To assess current approaches and language used by both subspecialist and non-specialist physicians when interviewing patients with suspected seizures to create a clinical tool to aide in seizure diagnosis.

Apart from subspecialist evaluation, patients frequently present for initial evaluation of seizures in emergency departments, urgent care clinics, and primary care clinics. Clinical history taking is often the most important factor in seizure recognition and the diagnosis of epilepsy. Yet the diagnosis of focal seizures remains challenging without a standardized and evidence-based approach to history taking, leading to significant delays in diagnosis.

We carried out semi-structured interviews with 10 physicians spanning a range of specialties, practice locations, and clinical experience. This included epilepsy specialists and non-specialists in fields where evaluation of new-onset seizures is common: emergency medicine, internal medicine, and family medicine. Thematic analysis was used to develop a “Seizure Identifier” questionnaire, which was subsequently reviewed by five independent experts for content and face validity. 

Our analysis revealed that across specialties and practice settings, physicians have a structured approach in evaluating patients who present with suspected seizures. Five key characteristics important for identifying seizures emerged across interviews: sudden-onset unprovoked symptoms, short lasting symptoms, strange or difficult-to-describe symptoms, highly stereotyped symptoms, and post-ictal symptoms. After independent review, these were translated into an eight-question “Seizure Identifier” tool.

This study highlights important concepts for clinical practice regarding seizure identification. By using themes from our analysis, we were able to create a tool that may aid non-specialists in the approach to history taking for patients who present with suspected seizures and may help improve time to subspecialist evaluation. Importantly, this tool can be tested in future research for improving seizure recognition and improving timely epilepsy diagnosis.