Optimizing the Patient’s History: A Modern Approach

Medical history taking is the starting point of the diagnostic process and still maintains its leading role today, despite the current development of laboratory tests and neuroimaging techniques. Subjects with photosensitivity have high susceptibility for an epileptic seizure provoked by visual stimuli and require a specific approach in gathering information, especially to ascertain the occurrence of reflex seizures and to identify triggering factors. This chapter addresses the way to ascertain: (a) the presence of reflex seizures induced by visual stimuli; (b) the triggering factors and environmental risk; (c) signs and symptoms to be investigated on the basis of the patient’s age and the main syndromes where photosensitivity is involved; (d) the occurrence of self-induced seizures with their psychosocial aspects. In these patients the medical history should be based on a multimodal approach: (a) face-to-face interviews with the patient and/or parents in the case of children; (b) specific questionnaire on environmental context and living habits; (c) to require collaborative patients to take photographs of stimuli they consider triggering; and (d) to ask them to draw the visual symptoms occurring during seizures. Since the clinical history should be conducted with a specific approach and targeted questions, it would be advisable to develop professional training courses on how to collect the medical history in epileptic patients with photosensitivity.