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 The diagnosis is established mainly based on clinical findings and electroencephalograms (EEGs) (Figure 1.2.6)Table 1.2.4 Clinical presentation of seizures.Source: Adapted from Scheffer, I.E., Berkovic, S., Capovilla, G. et al. (2017). ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58: 512–521.Type of seizureCharacteristicsSigns/symptomsFocal onset (may affect one lobe or a large part of one hemisphere)Focal aware or focal impaired awarenessMotor onset or non‐motor onsetCan be followed by a bilateral tonic–clonic seizureMotor symptomsAutomatisms (lip‐smacking, chewing movements, running, cycling, kicking, repeatedly picking up objects or pulling at clothes)Loud cry or screamTwitching, jerking or stiffening movements of a body partSudden loss of muscle tone or limbs suddenly becoming stiffNon‐motor symptomsChanges in sensation, emotions, experiencesFeeling of déjà vu (feeling like you have been here before)Unusual smell or tasteSudden intense feeling of fear or joyNumbness or tinglingVisual disturbances (coloured/flashing lights or hallucinations)Generalised onsetMotor (tonic–clonic/other) or non‐motor (absence)Tonic–clonicTypically last 1–3 minAt the start of the seizure:The person becomes unconsciousBody goes stiff and they may fallMay cry outMay bite their tongue or cheekDuring the seizure:Jerk and shake as their muscles relax and tighten rhythmicallyBreathing might be affected and become difficult or sound noisySkin may change colour and become very pale or bluishIncontinence may occurAfter the seizure:Often feel tired, confused, have a headache or want to sleepAbsenceMore common in childrenCan be frequentLast a few secondsTypical absences: ‘daydreaming’, blank, unresponsive, may be missedAtypical: start and end more slowly, can last longer, may also include reduced muscle toneUnknown onsetMotor (tonic/clonic/epileptic spasms) or non‐motorVariable symptoms as described aboveUnclassifiedDue to inadequate information/inability to place in the above categoriesFigure 1.2.6 Electroencephalogram (EEG) showing epileptiform activity.

 High‐resolution structural images (high‐field magnetic resonance) and functional radionuclide imaging (positron emission tomography/single‐photon emission computed tomography) can be useful (Figure 1.2.7)

 Genetic testing has gained importance in diagnosing some forms of epilepsy