Making a diagnosis

Tests are administered to patients to determine if a person has a form of epilepsy, and if so, what kind of seizures will result. To determine how epilepsy is affecting an individual, the care team can perform imaging and monitoring using an electroencephalogram (EEG), the most common diagnostic test, to assess whether there are any detectable abnormalities in the person’s brain waves; and any combination of a medical history test including symptoms and duration of the seizures; a series of blood tests to screen for metabolic or seizure-related genetic disorders; and/or developmental, neurological, and behavioral tests to measure motor abilities, behavior, and intellectual ability.

Is it a seizure or a seizure-like event?

A seizure doesn’t always simply epilepsy. In the case of a seizure, there are things that a neurologist may look at to determine the cause of the patient’s seizure. Seizures occur when abnormal electric signals from the brain change the way the body functions. There are many different types of seizures, which may cause anything from convulsions, muscle spasms, brief or prolonged loss of consciousness, strange sensations and emotions, and/or abnormal behaviors. Seizures can be triggered by an isolated incident such as high fever, infection, exposure to toxin, and metabolic abnormalities like hypoglycemia, but are frequently evidence of an underlying medical condition.

What to tell your doctor

In the case of a seizure, there are a variety of things a neurologist may analyze to determine the cause. Record the timing, experiences and any known triggers of your seizures in journal that you can share with your doctor. This will provide background to what you are experiencing and serves as useful information for the care team.

How do patients respond to medication?

While many patients will respond to anti-seizure medication, for over 30% of patients with epilepsy, the medication is not enough – these patients are “intractable” and do not respond to traditional epilepsy treatments and therapies. About half of patients will become seizure-free with the first anti-seizure medication, and approximately 15% of patients will achieve seizure freedom with a second or third medicine. For the rest of the patients with epilepsy their seizures remain uncontrolled. Unfortunately, the cause of the epilepsy is unknown in about 50% of cases, making treatment decisions more difficult to make.