Diagnosing Epilepsy - From WebMD


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Diagnosing Epilepsy - From WebMD

Diagnosing Epilepsy

The evaluation of patients with epilepsy is aimed at determining the type of seizures (epileptic versus nonepileptic) and their cause, since various seizure types respond best to specific treatments. The epilepsy diagnosis is based on:

* The patient's medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include:
o At what age did the seizures begin?
o What circumstances surrounded your first seizure?
o What factors seem to bring on the seizures?
o What do you feel before, during and after the seizures?
o How long do the seizures last?
o Have you been treated for epilepsy before?
o What medications were prescribed and in what dosages?
o Was the treatment effective?

* Others who have often seen you before, during and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness.

* A complete physical and neurological examination of muscle strength, reflexes, eyesight, hearing and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures

* An electroencephalogram (EEG) test, which measures electrical impulses in the brain

* Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI)

* Blood tests to measure red and white blood cell counts, blood sugar, blood calcium and electrolyte levels; and to evaluate liver and kidney function. Blood tests help rule out the presence of other illnesses.

* Other tests, as needed, including magnetic resonance spectroscopy (MRS), positron emission tomography (PET) and single photon emission computed tomography (SPECT)

*The most important part of the evaluation is the electroencephalogram (EEG) because it is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain's electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.

A routine EEG only records about 20 minutes of brain waves (however, the entire EEG procedure takes about 90 minutes). Because 20 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary.

Prolonged EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain's activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special hospital facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy.

Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.

WebMD Medical Reference provided in collaboration with the Cleveland Clinic