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Silent Witnesses in the Diagnosis of Epilepsy
  1. Geraint Fuller*,
  2. Andrea Lindahl
  1. *Consultant Neurologist and
  2. Specialist Registrar in Neurology, Department of Neurology, Gloucester Royal Hospital, Great Western Road, Gloucester, UK; E-mail: geraint{at}


Epilepsy is primarily a clinical diagnosis that depends on the patient’s account and – importantly – an accurate witness description of the attacks in the even to floss of awareness, consciousness or recall of the events. Unfortunately, not all ‘blackouts’ (loss of consciousness) are witnessed. So are there any useful clues – silent witnesses – that can tell us about the nature of a blackout under these circumstances?


Patient A: a 44-year-old man wakes in the morning feeling non-specifically unwell and notices that he has bitten the side of his tongue.

Patient B: a 36-year-old woman wakes in the morning feeling groggy and achy with mid-thoracic back pain, having gone to bed completely well the night before. Because of her back pain she attends her family doctor who arranges a plain X-ray, which shows a thoracic vertebral compression fracture (Fig. 1).

Patient C: a 64-year-old man wakes in the morning with

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