[Epileptic seizures as a key neurological symptom: diagnosis, differential diagnosis and management].

Abstract

Introduction: Epileptic seizures rank among the most striking neurological key symptoms and pose a particular diagnostic challenge, especially when occurring for the first time. Differentiating between provoked, unprovoked seizures and epilepsy is essential for making appropriate therapeutic decisions. A thorough medical history, supported by EEG, MRI, and laboratory tests, usually allows for a well-founded classification and helps exclude important differential diagnoses such as syncope or psychogenic non-epileptic seizures. The International League Against Epilepsy (ILAE) classifies seizures based on their origin into focal, generalized, and seizures of unknown onset, which facilitates therapeutic categorization. Acute management is particularly indicated in cases of seizure clusters or status epilepticus. The decision to initiate long-term antiseizure therapy should be made on an individual basis and depends on seizure type, etiology, risk of recurrence, comorbidities, and the patient's individual life circumstances. Patient education is a central aspect of management and should cover trigger factors, therapy adherence, everyday safety risks, and driving eligibility. Early and differentiated diagnostics combined with an individually tailored treatment approach can significantly improve the prognosis - around two-thirds of affected individuals achieve seizure freedom with antiseizure therapy.