Obtain a detailed history, addressing the presence of preceding aura, abrupt or gradual onset, progression of motor activity, incontinence, whether the activity was local or generalized and symmetric or not, duration, and the presence of postictal confusion or lethargy. If the patient has a known seizure disorder, ascertain previous seizure pattern, common precipitants, and any change in antiepileptic regimen. If there is no previous history of seizures, a more detailed inquiry is needed. Ask the patient about recent or remote head injury. Persistent, severe, or sudden headache suggests intracranial pathology. Pregnancy or recent delivery raises the possibility of eclampsia. A history of metabolic or electrolyte abnormalities, hypoxia, systemic illness (especially cancer), coagulopathy or anticoagulation, drug ingestion or withdrawal, and alcohol use may pinpoint predisposing factors. Seizures are a common manifestation of central nervous system (CNS) disease in patients with the human immunodeficiency virus, although their causes differ somewhat from immunocompetent patients (Table 145-2).