Diagnosis

If you have had a seizure, your doctor will try to determine what might have caused it, as well what types of treatment might be appropriate. Some questions the physician will try to answer include:

• Was the seizure a result of a short-term illness (fever, infection) or an incident that can be remedied?
• Was the seizure a result of a malfunction in your brain's electrical system?
• Was the seizure caused by something within your brain's structure?
• Was the seizure an isolated incident or do you have a pattern of seizures?

Answering these questions will involve you as a patient undergoing some physical tests conducted by your physician and other trained medical staff. These tests will most likely include a detailed and complete medical history, a thorough physical examination, blood tests, an electroencephalograph (EEG) test, and magnetic resonance imaging (MRI) and/or computed tomography (CT) scans.

Medical History

Your medical history will be some of the most important information your doctor needs in reaching a diagnosis of epilepsy. In particular, your doctor will want to know as much information as possible about your seizures from beginning to end — any unusual feelings you may have prior to, during, or after the seizure, how long the seizure lasts, what happened during the seizure, and how many seizures you have had. If you do not know what happens during your seizures, bring someone with you to your doctor's appointment that has seen your seizures, or bring a written description from someone who has witnessed your seizures. Giving the doctor as much descriptive information as possible will help the doctor to reach an accurate diagnosis.

Blood Tests

Blood tests may be ordered to determine the general physical well-being of your body. These tests can also be used to detect if you have an infection or been exposed to any poisons that may have caused your seizures.

Blood tests will also be used to monitor anti-seizure medication levels in your blood. This test is called a "blood level." These levels are important because they will help tell you and the doctors that the anti-seizure medications you are taking are at an effective dosage level in your body. The goal of treatment with anti-seizure medications is to reach a dosage level that stops the seizures without creating any side effects. This level is called a "therapeutic level" and can be unique from person to person. A dose of medication that makes you feel sick because there is too much medicine in your bloodstream is called a "toxic" level, and each person's toxic level of medication will be different, too.

Electroencephalograph (EEG) Tests

An EEG test may be ordered by your doctor to determine if there is any unusual electrical activity in your brain that may produce seizures. The test, which is safe and painless, consists of a technician pasting electrodes, or small metal discs with thin wires, onto your scalp. These electrodes then transmit your brain's electrical impulses to a computer, which prints out the activity as a series of wavy or spiked lines. Any abnormal patterns will show up on the print-out, and these patterns will help your doctor in making a diagnosis of your seizure type, where in your brain your seizure activity is starting, and even what courses of treatment might work best for you.

The test, which can last anywhere between a half hour and an overnight stay, typically takes place in a hospital or outpatient epilepsy clinic. Often, the tests are videotaped, which may also assist a doctor in making a diagnosis if you happen to have a seizure while you are being monitored.

The technician may ask you to perform simple tasks while wearing the electrodes, including taking deep breaths through your mouth, blinking your eyes rapidly, or looking at a flashing light.

Children should be prepared in advance of an EEG test so as to make the experience as stress-free as possible. You can encourage your child to "practice" on a doll or stuffed animal.

Sometimes the history indicates that a person is having seizures, but the EEG results indicate normal brain electrical activity. If this is the case, the doctor may order a longer EEG test or one that uses special, ultra-sensitive electrodes that can pick up on fainter electrical impulses from your brain.

Brain Imaging

Several different types of tests that give your physician images of your brain may be ordered, including an MRI (Magnetic Resonance Imaging) or a CT (Computed Tomography) scan. Both types of tests help a doctor determine if there are any physical changes in your brains structure (including tumors, blood clots, malformations or scar tissue) that may be causing your seizures.

The tests are performed by a machine that looks something like a front-loading washing machine. You will lie on an examination table in front of the machine which will be slowly moved forward so that your head is inside the imaging chamber

As with the EEG test, an MRI or CT scan is safe and painless, and children should be prepared in advance so that they know what to expect.