Taking a clinical history in adolescents and adults presenting with seizures or epilepsy

Despite advances in EEG, neuroimaging, and other diagnostic technologies, a carefully obtained clinical history remains the cornerstone of diagnosis, classification, and treatment planning. However, structured guidance on history-taking that integrates state-of-the-art evidence and the updated 2025 International League Against Epilepsy (ILAE) seizure classification is limited. We performed a review of evidence published between January 2000 and April 2026, supplemented by landmark earlier studies, ILAE position papers, and National Institute for Health and Care Excellence (NICE) guidelines. Evidence was synthesized to develop a practical framework for obtaining and interpreting the clinical history in adolescents and adults presenting with a first seizure, recurrent seizures, or established epilepsy. We present a structured approach that follows the sequence of a clinical consultation, encompassing the presenting complaint, detailed event reconstruction, semiology, collateral witness accounts, smartphone video recordings, seizure triggers and temporal patterns, past medical history, medication review, family history, social factors, and safety issues. We discuss the diagnostic value of individual history elements, practical strategies for distinguishing epileptic seizures from functional/dissociative seizures and syncope, and the contribution of history-taking to seizure classification under the updated 2025 ILAE framework. We also summarize clinically relevant risk factors, comorbidities, and management implications that influence diagnostic accuracy and individualized care. Practical diagnostic questionnaires are provided to facilitate differential diagnosis and seizure classification, particularly for clinicians without specialist epilepsy expertise. A systematic clinical history, obtained from the individual and eyewitnesses and complemented by video recordings when available, remains the single most important diagnostic tool in epilepsy. Structured history-taking improves diagnostic accuracy, reduces misdiagnosis, supports accurate seizure classification, guides appropriate investigations, and provides the foundation for personalized management. This practical framework offers an evidence-based approach that can be readily incorporated into routine clinical practice and education across diverse healthcare settings.