Comment: Be careful what you ask when interviewing patients with epilepsy

Clinicians rely on reported seizure symptomatology, observed semiology, and EEG data to distinguish between focal-and generalized-onset seizures. In the absence of external observations or corroborating EEG findings, it is tempting to believe that if we ask patients the right questions, their description of what a seizure feels like will illuminate the right diagnosis. Specifically, eliciting symptoms usually associated with focal-onset seizures should be clarifying. Not so much, according to the accompanying article by Seneviratne et al.1 The notion that focal seizure symptoms definitively identify focal-onset seizures appears to be dying, if not dead, dogma.