The initial diagnosis of seizure is based on the history. If first-line treatment fails, the diagnosis is (or should be) questioned and verified. At epilepsy centers, where selected challenging patients are seen, the evaluation typically begins with video-EEG monitoring, which allows a clear diagnosis in the vast majority of cases (Benbadis et al 2004; Benbadis et al 2009). Typically, video-EEG will answer the following questions:
(1) Is it epilepsy or not?
(2) If it is not epilepsy, what is it?
(3) If it is epilepsy, what type?
(4) If seizures are focal, where is the focus?
In this article, we will focus on the first 2 questions. Is it epilepsy or not? If it is not epilepsy, what is it? In the vast majority of cases, the question of “epilepsy or not” is easily answered, so we will focus on the relatively small proportion of situations in which, despite good EEG or video-EEG recordings, the question remains difficult to answer. We will divide “ambiguous” events into clinical and electrographic events.
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