National voluntary agency dedicated to the welfare of people with epilepsy.

 

Diagnosing Epilepsy and talking to your doctor

Provide Information to Help the Doctor

If you have had a seizure and you seek medical help, your doctor will want to know:

Was the seizure caused by a short-term problem (like fever or infection) that can be corrected?

Was it caused by a continuing problem in the way your brain's electrical system works?

Is there anything about the structure of your brain that could cause seizures?

Was the seizure an isolated event, or does it mean that you have epilepsy?

Diagnostic Methods and Tools

The doctor's main tool in diagnosing epilepsy is a careful medical history with as much information as possible about what the seizures looked like and what happened just before they began. The doctor will also perform a thorough physical examination, especially of the nervous system, as well as analysis of blood and other bodily fluids.

A second battery of diagnostic tools include an electroencephalograph (EEG). This is a machine that records brain waves picked up by tiny wires taped to the head. Electrical signals from brain cells are recorded as wavy lines by the machine. Brain waves during or between seizures may show special patterns which help the doctor decide whether or not someone has epilepsy.

Imaging methods such as CT (computerized tomography) or MRI (magnetic resonance imaging) scans may be used to search for any growths, scars, or other physical conditions in the brain that may be causing the seizures. In a few research centers, positron emission tomography (PET) imaging is used to identify areas of the brain which are producing seizures.

Which tests and how many of them are ordered may vary, depending on how much each test reveals.

The Decision to Treat

When a child or adult experiences a single seizure, or appears at the doctor’s office with a history of questionable events that may or may not have been seizures, the first issue is to determine what happened, whether a seizure actually took place, of what type and duration it was, the possible cause, and the future prognosis.

Once this information is gathered, the next question is whether to treat the underlying condition (if one has been identified and if it is treatable), or whether to treat the symptoms by prescribing antiepileptic (or seizure-preventing) drugs. Find out more about the decision to treat.

Definitions:

Computerized tomography (CT):A scanning method that uses X-rays and computers to create images of the internal structure of the brain, produced at different levels, in a series of 'slices.'

Magnetic resonance imaging (MRI): An imaging method using magnets instead of X-rays. Produces detailed pictures of the internal structure of the brain.

Prevalence and Incidence

More than 3 million people in the U.S. have some form of epilepsy. About 200,000 new cases of seizure disorders and epilepsy are diagnosed each year.

Treatment:

When the doctor has made a diagnosis of seizures or epilepsy, the next step is to select the best form of treatment. If the seizure was caused by an underlying correctable brain condition, surgery may stop seizures. If epilepsy -- that is, a continuing tendency to have seizures -- is diagnosed, the doctor will usually prescribe regular use of seizure-preventing medications. If drugs are not successful, other methods may be tried, including surgery, a special diet, complementary therapy or vagus nerve stimulation (VNS). The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for people to lead active lives.

The Decision to Treat

"The decision to treat becomes a highly individualized one."

Factors Influencing the Decision to Treat

      Abnormal EEG

      Previous seizure

      Driver

      Other neurological impairment

      Elderly

When a child or adult experiences a single seizure, or appears at the doctor’s office with a history of questionable events that may or may not have been seizures, the first issue is to determine what happened, whether a seizure actually took place, of what type and duration it was, the possible cause, and the future prognosis.

Once this information is gathered, the next question is whether to treat the underlying condition (if one has been identified and if it is treatable), or whether to treat the symptoms by prescribing antiepileptic (or seizure-preventing) drugs.

Factors Influencing the Decision Not to Treat

      Single seizure

      No history

      Neurologically normal

      Young age

      Side effects

Unless the EEG is clearly abnormal, thus increasing the likelihood of subsequent seizures, physicians tend to wait until a second or even third seizure occurs before beginning antiepileptic medication. They do so because studies show that an otherwise normal child who has had a single seizure has a relatively low (15%) risk of a second one. Once the second has occurred, the risk of subsequent seizures is substantially increased.

On the other hand, the risk of another seizure for a child who is neurologically abnormal, or whose EEG is abnormal, may be as high as 50-60%.

In determining whether to treat, physicians consider the risk-benefit ratio, which varies according to the age of the patient and his or her activity level. Waiting to see whether another generalized tonic-clonic seizure occurs is less risky for a child living in a sheltered home environment than it is for a salesman who lives most of his life driving a car, or an elderly person with brittle bones. On the other hand, antiepileptic drugs have side effects which, while generally mild, can in some cases include liver damage and potentially fatal rashes and blood disorders. Thus the decision to treat becomes a highly individualized one in which the risks of the treatment are weighed against the risks of the seizures.

There is debate about whether or not children with febrile (fever caused) seizures should be placed on antiepileptic drugs. Current opinion favors withholding therapy for most of these children, since side effects of the medication may cause more problems than recurrent febrile convulsions. There may be instances, however, when treatment is prescribed.

Things to Know:

Ask your doctor ahead of time what to do if you forget a dose of your medication. Don't stop taking your medicine suddenly. It could cause non-stop seizures that would put you in the hospital and might even threaten your life.

Tell your doctor if you notice any unusual changes in health, feelings or behavior when you are taking your medicines.

Be careful about drinking alcohol. Check with your doctor about how these drinks will mix with your medicine.

Think about things you want to ask before you see the doctor. Write them down so you don't forget.

Keep follow-up appointments. You may need to have special tests from time to time to make sure the medications you take aren't doing anything to your body that might be damaging.

Tell doctors planning surgery for you, or treating you for other medical conditions, that you have epilepsy and what medicine you take for it. Write down its name and dosage and keep it in a safe place.

Ask your doctor if there are any cold pills, fever medicines or other drug-store products that you should not use because you take epilepsy medicine.

If your doctor changes your medicine, don't drive until you know how it's going to affect you.