Evaluation Of The Patient With Spells History

The key features of a spell history include setting, prodrome, time course, stereotypy, precipitating and ameliorating factors, behavior during the episode, and the nature of recovery (Table I-2).

The history should be taken from the patient and from an observer, since an alteration of consciousness by definition impeaches a patient's capacity to fully describe the episode. With complex partial or absence seizures, and in some transient ischemic attacks, it is common for a patient to maintain that there was no loss of consciousness, whereas an observer will report a clear interval of partial or complete unresponsiveness. In spell diagnosis, a phone call to an observer is always a worthwhile effort.

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