Epilepsy: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps.

The patient is assessed using the Glasgow Coma Scale. This contains the following criteria:

Criterion Score
Eye opening spontaneous 4
on request 3
on pain stimulus 2
no reaction 1
Verbal communication conversational, oriented 5
conversational, disoriented (confused) 4
incoherent words 3
unintelligible sounds 2
no verbal reaction 1
Motor response Follows prompts 6
Targeted pain defense 5
untargeted pain defense 4
on pain stimulus flexion synergisms 3
on pain stimulus stretching synergisms 2
No response to pain stimulus 1

Assessment

  • Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
  • If the score is 8 or less, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
  • With a GCS ≤ 8, airway protection must be considered.

This is followed by a comprehensive physical and neurologic examination:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection
      • Skin and mucous membranes [injuries?, bruise marks?, signs of intoxication?]
      • In the current presence of epilepsy [distinction between seizure? and flexion/extension synergisms in entrapment?]
    • Auscultation of the heart
    • Auscultation of the lungs
    • Palpation of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?)
  • Neurological examination – including.
    • Examination of pupillary response, reflex testing, etc.
    • Examination for meningismus [meningismus? (esp. note in presence of febrile infection)]]
    • If postically responsive patient [persistent focal neurologic deficit?]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.