Definitive tests for epilepsy?

[Dave111]

Is it possible to definitively diagnose epilepsy? Given that more people supposedly have abnormal EEG’s than have epilepsy then this does not indicate that epilepsy is present. Equally given that seizures could be occurring during sleep or being absence seizures they may not be pronounced enough to be easily observable? How do they then diagnose the condition?

[Bernard]

There are a lot of people that get definitive diagnosis with a clear answer as to what caused their epilepsy. There are also a lot of people who never get either.

Epilepsy is an umbrella term that emcompasses a wide spectrum of possibilities. Some are easier to define and measure/test than others.

In my wife's case, her seizure patterns have changed dramatically over the years - in terms of seizure types, frequency, timing, apparent triggers, etc. to the point that if she had seen a new neurologist at different points in time who didn't know her past history, she would have received different several specific diagnoses. Based upon her experience, I'm not convinced that a specific diagnosis of epilepsy is really a static state anyway.

[Crystal11]

Epilepsy has many seizure types. Absence seizures show 3 per second spike and wave waveforms on the EEG. Most people with Epilepsy have spike and wave that show up even if a seizure does not occure. Those spike and waves are characteristic to Epilepsy, and the type (speed, duration tells what kind) Some people have abnormal looking EEGs but don't ever have Epilepsy or seizures.
People have to be diagnosed by history and witnesses, family history and experience before, during and after the seizure. Depending on what happens- a neurologist can tell what side of the brain, where (general area), where it starts from and then they sometimes can tell where it spreads to. Some people's seizures can spread from one side of the brain to the other.
EEGs are not used to confirm an Epilepsy diagnosis but it definitely helps in telling what kind of seizure is happening and show specific waveforms.

Take care
Crystal

[Nakamova]

A diagnosis is usually made on the basis of clinical evidence (i.e. the actual seizures), as well as EEG/MRI data. If the doctors can't witness the actual seizures, then the EEG can be helpful to confirm what the patient reports. In the absence of both forms of evidence, it can be pretty tough to diagnose obviously, but there is an additional, less desirable method -- to treat for epilepsy (By prescribing an anti-epileptic drug) and then see if the patient reports an improvement.

[Dave111]

I thought that with absence seizures that it may not even be obvious that a seizure is occuring (such as with absence or simple partial seizures); even more so when people are asleep. Consequently wouldn't there potentially be a large number of people with epilepsy who would not know it (and for whom it could not be easily tested unless you did repeated sleep studies over many nights)?

[Meetz1064]

tell you the truth, unless the sleep study has a thorough EEG done during it, then you can't know for sure. It is more reliable to have a separate, 24 to 48 hour (preferably longer) EEG done. This way, any possible nighttime activity is captured on the EEG, and documented. And the longer you're hooked up to the EEG, the better chances you'll have of finding proof of the possible seizures....

[BuckeyeFan]

I also believe that E can change over time. This may be a natural progression due to age or other factors. It could also be the result of treatments solving some types of seizures, than others breakthrough.

In past times, my mind has felt like a spring that winds tighter and tighter, then would actually felt released after a tonic-clonic seizure. Now that the tonic clonic seizures are controlled, I find other issues coming forth. Either that or I did not pay as much attention to them when the tonic clonic seizures were the main problem.

[Bernard]

I thought that with absence seizures that it may not even be obvious that a seizure is occuring (such as with absence or simple partial seizures); even more so when people are asleep. Consequently wouldn't there potentially be a large number of people with epilepsy who would not know it ...?

Yes. We see new members all the time who were diagnosed after a experiencing a tonic clonic who have an epiphany that they have been experiencing absence and/or simple partial seizures for years but didn't know that the events were seizures until they started exploring the world of E post-diagnosis.