Patients may report "spells" or fainting that raises suspicion of seizure, a sudden excessive electrical discharge from cortical neurons. Seizures may be symptomatic, with an identifiable cause, or idiopathic. A careful history is important to rule out other causes of loss of consciousness and acute symptomatic seizures that have discernible explanations.

If there is more than one seizure, consider epilepsy, defined as two or more seizures that are not provoked by other illnesses or circumstances.38,39 The incidence of epilepsy in the United States is 3%; in more than 60% to 70% of affected patients, no cause is identified.

Epilepsy does not always involve loss of consciousness, depending on the type. It is usually classified as generalized or partial, based on the location in the cortex of the initial seizure focus. If available, ask a witness how the patient looked before, during, and after the episode. Was there any seizure-like movement of the arms or legs? Any incontinence of the bladder or bowel? What about any drowsiness or impaired memory after the event suggestive of a postictal state?

Ask about age at onset, frequency, change in frequency or symptom pattern, and use of medications, alcohol, or illicit drugs. Check for any history of head injury

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