Epilepsy physical examination

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 of patients with epilepsy is usually remarkable for:

• 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]

• 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]

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

• 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 examination of patients with epilepsy is usually normal.

• 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

• Tachycardia before, during and after seizure^[10]

• Abdominal examination of patients with epilepsy is usually normal.

• Back examination of patients with epilepsy is usually normal.

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

• 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 examination of patients with epilepsy is usually normal.

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