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disorder (NEAD) sufferers articulate the description of the seizures, compared to those with
epileptic seizures8. With experience, one learns to identify non-verbal clues during the
clinical encounter that can be diagnostically helpful.
Increasingly video recordings, particularly on mobile phones, are available. There are caveats
to their use, mainly the fact that the beginning of the attack may be missed, but these
recordings are easily available, and in most cases are superior to descriptions alone. Other
sources of video recordings, including CCTV footage, can be diagnostically useful. Time and
effort spent in trying to obtain such footage will be well worth it.
Formal diagnostic video telemetry (VT), capturing all the different types of attacks
experienced by the patient, remains the gold standard investigation in clarifying the diagnosis.
However, most epilepsy monitoring units based in acute hospitals can only admit patients for
a week or two, and it is common for patients to have no, or only some attacks. Thus,
information from VT usually only forms part of the diagnostic work up. Longer-term
monitoring over several weeks can currently be performed only at the NSE in London, and
at Quarriers in Glasgow; selected cases may require referral to these centres for diagnostic
clarification.
Whichever method is used for reviewing the diagnosis, the objective is to achieve a clear
understanding of the nature of each type of episode, which the patient and their family
members/carers are also able to understand. This should then enable appropriate management
of each type of seizure. It is especially important to have a written care plan for each type of
attack where epileptic and non-epileptic attacks co-exist, and where professional carers are
involved (see Figure 1 for an example). This document should be available to all involved in
the patient’s care (patient/carer, GP, hospital notes) so that each type of attack can be
managed appropriately, and the risk of iatrogenic harm minimised.

Figure 1. Care plan for management of seizures and behavioural attacks in a patient with
moderate learning difficulties and refractory epilepsy due to tuberous sclerosis.