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November 1987

First Seizure Management—Reconsidered: Response II

Author Affiliations

From the Department of Neurology, The Johns Hopkins Hospital, Baltimore.

Arch Neurol. 1987;44(11):1189-1190. doi:10.1001/archneur.1987.00520230069018

Medicine comprises the art of treating in the face of uncertainty. On many occasions, patients present their doctors with diagnostic dilemmas regarding their "spells." Such episodes may represent seizures, transient ischemic attacks, atypical migraine, syncope, presyncope, cardiac irregularities, sleep disorders, inter-mittent movement disorders, fluctuating metabolic encephalopathies, and a host of psychological or psychiatric entities including hyperventilation spells, panic attacks, conversion reactions, or malingering. Rarely is the physician afforded the opportunity personally to witness a spell, or, alternatively, to talk to fully qualified dispassionate observers.

In some instances, a patient expresses concern about whether his or her condition is "epilepsy," but more often the patient simply wants to know if he or she has anything serious, and whether treatment is required. The most legitimate start of a physician's answer to these queries is the phrase: "Chances are...." I have many times told patients that they might have had a

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