A Answers (9)
Honor Society of Nursing (STTI) answeredIn order to diagnose your seizure disorder, also known as epilepsy, your doctor will consider your symptoms, review your medical history, and conduct a neurological exam. The neurological exam will allow your doctor to evaluate your intellectual functioning, motor skills, and behavior. Your doctor might also ask you to undergo further tests, such as an electroencephalogram (EEG) that measures your brain activity or an imaging scan of the brain. An EEG involves placing electrodes on your scalp that measure the patterns of your brain waves. This test is most valuable if it is performed within 24 hours of your first seizure. Imaging scans of the brain can reveal problems in the structure of the brain, and some kinds of imaging scans can also show brain activity. When diagnosing some patients, particularly children, doctors will often order a blood test to check for illnesses and disorders that could cause seizures.
Anyone who has had an epileptic seizure, even if it is thought to be reactive, deserves a full neurological evaluation, which consists most importantly of a careful history, neurological examination, description of the seizure(s) and routine laboratory tests, as well as a brain-wave test (electroencephalogram – EEG), brain imaging (magnetic resonance imaging – MRI), and in the case of some syndromes, genetic screening. The first objective is to rule out a large variety of intermittent neurological, general medical, and psychiatric conditions that can mimic epilepsy (nonepileptic seizures, pseudoepilepsy). It is essential that such disorders are recognized and treated, and that the patient is not mistakenly diagnosed with epilepsy. If another disease is suspected special tests may be required. Next, it is important to look for an underlying treatable cause because if such a cause is treated and the seizures stop, the patient does not have epilepsy. Then the diagnosis of epilepsy requires either two epileptic seizures occurring more than 24 hours apart that are not reactive, or one such seizure and evidence from history, EEG, MRI or other tests of an enduring brain abnormality that makes it highly likely that more seizures will occur. When there is difficulty distinguishing between epilepsy and a condition that causes nonepileptic seizures, referral to a specialized epilepsy center is recommended for in-patient video-EEG monitoring in order to carefully evaluate the electrical and behavioral features of the habitual seizures.
Scripps Health answered
Diagnosis begins with a thorough history, followed by a series of diagnostics, including blood tests, MRIs and electroencephalograms (EEGs), which record electrical activity in the brain and can often distinguish whether a seizure is actually epilepsy. The EEG can also determine which parts of the brain are being affected to help devise a treatment strategy.
Epilepsy by definition means having more than one unprovoked seizure (meaning nothing else caused it such as low blood sugar or other electrolytes, substances like alcohol, or a bleed in the brain). The diagnosis is made through a careful history (very useful to have observers other than the patient there). A diagnosis can often be confirmed with an EEG (brain wave study) or MRI of the brain, however, if these studies are normal, history trumps the studies. If there is still question around the diagnosis and episodes are occurring frequently, a concrete diagnosis can be made by elective admission for continuous video-EEG monitoring, where a patient is admitted until their episodes are recorded; this will lead to a definitive diagnosis in the great majority of patients.
Doctors will ask about the individual's history of seizures, along with other diseases, surgeries, and medications. A thorough history of recreational drug and alcohol use or abuse is equally important. It is helpful for the doctor to distinguish seizure subtypes, partial or generalized; time of day of the event, including whether the seizure occurred during wakefulness or sleep; and any known triggers, such as a flickering light, severe sleep deprivation, or dehydration.
Doctors will perform a complete physical examination. A complete physical examination will include a neurological examination and brain function tests.
Laboratory data utilized in the diagnostic evaluation of patients with seizure disorders may include CT scan imaging, magnetic resonance imaging (MRI), and electroencephalograph (EEG). A complete blood panel, including drug-toxic screening and urinalysis are usually performed. Urine tests can determine if the individual is having a seizure due to illicit drug use, such as cocaine or methamphetamine. Blood tests will determine the basic functioning of the body, such as electrolyte (including sodium and potassium) levels and kidney and liver function.
A blood test that measures the hormone prolactin may be used to determine if a seizure was caused by epilepsy. The test, which must be used within 10-20 minutes after a seizure, measures levels of the hormone prolactin in the blood. Prolactin is produced by the pituitary gland, but an area of the brain called the hypothalamus controls its release. Researchers think that epileptic seizures affect the hypothalamus and may alter the release of prolactin, causing levels of the hormone to rise.
Conditions resembling seizure disorders: Seizure disorders must be differentiated from a variety of problems whose symptoms approximate or closely resemble those of epilepsy. These include cerebrovascular (stroke-related) disorders, migraine, narcolepsy (a neurological condition with uncontrollable sleep attacks and persistent daytime sleepiness), syncope (fainting), and anxiety.
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The first and most important step in diagnosing seizure disorders is to describe in detail the nature of the episodes that are occuring. Obtaining a history of suspected seizures is generally the most important part of making the diagnosis. Often it is very helpful to have friends and/or family members who have witnessed these events available to describe their observations as well.
Once a detailed history is obtained, a careful neurological and general medical examination is required.
Often additional diagnostic procedures will be ordered to aid and enhance the diagnostic process. These may include an electroencephalogram (EEG), CT and MRI brain scan, electrocardiogram (ECG), and sometimes lab work can be helpful also.
Hopefully when this process has been concluded the physician will be able to establish whether or not a person is suffering from a seizure disorder and initiate the appropriate treatment.
The diagnosis of epilepsy is based on careful and detailed accounts of the typical seizure as described by both the patient and the witness. This clinical information is more important in the diagnosis than any one of the subsequent tests. In addition to that, an EEG (electroencephalogram) may help confirm the suspected type of epilepsy. The EEG capturing the typical seizure has the highest diagnostic sensitivity, ideally with a video- EEG. If EEG is obtained between the seizures it may be entirely normal, and in this case is considered non-diagnostic. MRI of the brain is also required most of the time and is commonly normal. In addition, MEG (magneto-encephalography) is also helpful in the diagnosis of epilepsy.
Jeanne Morrison, PhD, Family Medicine, answeredYour physician will make a diagnosis of epilepsy based on several criteria. Probably the most important tool is a complete summary of your health history and an accurate and complete description of your seizure activity. Abnormal findings on your electroencephalogram (EEG) will also be helpful in making a diagnosis of epilepsy. Other diagnostic tools may include lab work, a computed tomography (CT) scan, magnetic resonance imaging (MRI), cerebral angiography, single-photon emission computed tomography (SPECT), magnetic resonance angiography (MRA), magnetic resonance spectroscopy (MRS), and/or positron emission tomography (PET) scan.
NewYork-Presbyterian Hospital answered
Advanced diagnostic tests for diagnosing epilepsy include:
- In-patient monitoring: Determines the frequency and severity of seizures and verifies the seizure type and site of onset in the brain.
- Imaging tests: Includes MRI (magnetic resonance imaging), SPECT (single-photon emission computed tomography), and PET (positron emission tomography) scans to locate the exact source of the seizures.
- Additional tests: Including Wada and functional MRI to identify the critical areas of the brain that are close to the source of the seizures.
- Neuropsychological tests: To assess cognitive functioning.
The results of these tests help classify each patient's seizures and determine the next step in treatment—whether additional medications or surgery—that is most likely to eliminate seizures.