Epilepsy - Diagnosis and Treatment

Diagnosis

Health professionals use several steps and tools to find out if someone has epilepsy. They aim to identify the type of seizures, find the cause, and decide on the best care. Specialists from neurology, radiology, and genetics each collect important patient details.

Finding the Cause

Doctors start by learning about the patient’s symptoms and medical history. They ask about how seizures look, their length, and how often they happen. They may also ask about family history and past illnesses.

Physical and Neurological Exams

Doctors perform a neurological check as one of the first steps. They look at behaviors, muscle movements, reflexes, and thinking skills. These tests show if the brain is working well and help spot changes linked to seizures.

Lab Tests and Genetic Checks

Doctors use blood tests to look for infections or other conditions that might cause seizures. They may order genetic tests, especially in children, if they suspect genes play a role. These tests can show changes in genes linked to epilepsy.

Brain Imaging Tests

Doctors use brain scans to look for problems.

Computerized Tomography (CT) Scan: X-rays create pictures of the brain. These images can show tumors, bleeding, or cysts.
Magnetic Resonance Imaging (MRI): A strong magnet and radio waves make detailed images of the brain’s structure. MRI can find abnormal or damaged areas.
Functional MRI (fMRI): This test shows which part of the brain works during certain tasks. Doctors use it to see which areas control speech or movement before surgery.
Positron Emission Tomography (PET): After a small amount of safe radioactive material is injected, PET shows how the brain uses energy. Areas using less energy may be where seizures start.
Single-Photon Emission Computed Tomography (SPECT): SPECT uses a safe radioactive material to make a 3D picture of blood flow during a seizure. More blood flow in a spot may show the seizure’s starting point.

Brainwave Recording (EEG)

Doctors use the electroencephalogram (EEG) to measure brain activity. They place small electrodes on the scalp to record electrical signals. If a person has epilepsy, the EEG may show unusual brain wave patterns, even when no seizure is happening.

Doctors often use video EEG to match movements with brain activity. Sometimes, people wear the EEG at home for a few days (ambulatory EEG) to catch rare seizures. High-density EEG uses more electrodes close together to help find the exact spot linked to seizures.

Below is a table with key brain imaging and EEG tests:

Test Name	What It Does	What It Finds
CT Scan	X-ray images of brain slices	Tumors, bleeding, and cysts.
MRI	Detailed structural brain images	Abnormal tissue, scarring, and injuries.
Functional MRI (fMRI)	Measures blood flow during brain activity	Areas for speech, movement, etc.
PET Scan	Monitors brain metabolism.	Areas with low or high brain activity.
SPECT	Maps blood flow during or after seizures.	Finds seizure origin.
Standard EEG	Tracks brain’s electrical activity.	Abnormal wave patterns.
High-Density EEG	More precise mapping of brain activity.	Pinpoints seizure location.
Ambulatory EEG	Records brain activity over several days at home.	Detects rare or nighttime seizures.
Video EEG	Films patient while recording brainwaves.	Matches seizures with EEG signals.

Neuropsychological Testing

Doctors use written and spoken tests to check thinking, memory, and speech. These results show which brain areas are affected by seizures.

Other Mapping Tools

Doctors may use advanced tools for more information.

Statistical Parametric Mapping (SPM): Compares the patient’s blood flow to normal brains to find seizure origins.
Subtraction Ictal SPECT Coregistered to MRI (SISCOM): Combines SPECT and MRI for a clearer map of the problem area.

These advanced tests help when basic imaging or EEG does not give enough answers.

Seizure Diaries and Action Plans

Patients and caregivers keep track of seizures by writing down when they happen, how long they last, and what they look like. Some families use a “seizure action plan” with steps for teachers, nurses, or adults during a seizure. The plan lists medicines to use and when to call for help.

Monitoring Devices

Some people have seizures at night or without warning. Special wearable devices can sense certain seizures, mainly those with shaking. These devices alert caregivers and help keep people safe.

Reasons for Many Tests

Epilepsy is not one illness, and seizures look different in each person. Some seizures cause shaking or loss of awareness, while others are subtle.

Doctors often use several tests to find the seizure type and cause. Most people need more than one kind of test. Knowing the type helps guide treatment.

Types of Seizures

Doctors group seizures into types:

Absence Seizures: Brief staring spells lasting a few seconds.
Generalized Tonic-Clonic Seizures: Cause stiffening, shaking, and sometimes loss of awareness.
Focal Seizures: Start in one brain area and may cause unusual feelings or movements.

Medically Refractory Epilepsy

Sometimes, standard medicine does not stop seizures. Doctors call this drug-resistant or medically refractory epilepsy. In these cases, doctors may order more tests to see if surgery can help. They use very detailed pictures and brain mapping before surgery to plan the safest operation.

Role of Family and Caregivers

Families and caregivers play a key role in finding epilepsy. They notice details before, during, and after seizures. Writing these details in a diary or calendar helps the health team plan care.

Sample Seizure Diary Entry Table

Date	Time	Seizure Type	Length	What Happened	What Helped
2025-03-01	10:05	Absence	6 sec	Stared, unresponsive	None needed
2025-03-05	09:11	Generalized tonic-clonic	3 min	Shaking, lost awareness	Medication
2025-03-11	17:20	Focal	90 sec	Hand shaking, confusion	Recovery position

Why EEG Is Important

Doctors use EEG to measure brain activity linked to epilepsy. It is safe and painless. EEG patterns can change even without a seizure, giving clues about the type of epilepsy. Doctors may ask patients to be a little sleep-deprived before the EEG. Lack of sleep can make seizures easier to catch on the test.

Monitoring for Subtle or Nighttime Seizures

Some seizures, like absence seizures, are hard to spot because they do not cause big movements. Video EEG, sometimes over several days, helps catch these by linking actions with brain wave changes. For people with nighttime seizures, long video EEG or home EEG makes it easier to record all events.

Treatment

Medicines to Control Seizures

Doctors most often manage epilepsy with medicines that control seizures. These are called anti-seizure or anti-epileptic drugs. Many people become seizure-free with one medicine.

Others need more than one drug to reduce how often seizures happen or make them less severe. There are over 20 kinds of anti-seizure medicines. Doctors choose the medicine based on seizure type, age, and other health issues.

They also check other medicines the patient takes to avoid bad interactions. Common steps for medicine management:

Start with a low dose of one medicine.
Slowly increase the dose until seizures are controlled.
Change or add medicines if needed.

Possible side effects:

Mild Side Effects	Serious Side Effects
Tiredness	Depression
Feeling dizzy	Suicidal thoughts
Weight gain	Severe skin rashes
Weak bones (bone loss)	Liver inflammation
Skin changes (rash)
Trouble moving or speaking
Memory or thinking problems

Most side effects are mild and go away over time. Tell a doctor if serious symptoms start.

Tips for Success

Always take medicines as the doctor says.
Call before changing to generic versions or adding new drugs or herbs.
Never stop medicine on your own.
Tell your doctor right away about a depressed mood or harmful thoughts.
Share if you have migraines; some medicines help both conditions.

Many people newly diagnosed with epilepsy get good seizure control after starting their first medicine. If medicine alone does not work, doctors may consider surgery or special devices.

Brain Surgery as an Option

If medicines do not control seizures, brain surgery may be another choice. In this procedure, the surgeon removes the small part of the brain that causes the seizures.

Doctors recommend surgery when seizures start in a very specific area of the brain. They consider it when the area can be removed without affecting speech, movement, or vision.

There are also less invasive choices, like laser therapy. Surgeons use a thin laser probe, guided by MRI, to destroy the brain tissue causing the seizures without open surgery.

After surgery, many people continue taking medicines, but often at lower doses. Surgery has some risks, such as changes in memory or thinking, so patients should

Device-Related Treatments

Some people with epilepsy benefit from devices that use electrical stimulation. These therapies may not replace medicine, but they can help reduce seizure frequency.

Types of stimulation therapies:

Stimulation of the Vagus Nerve
- Doctors place a small device under the skin in the chest.
- Wires connect it to the vagus nerve in the neck.
- The device sends electrical signals to the brain through that nerve.
- For many people, this can reduce seizures by 20% to 40%.
- Side effects may include a sore throat, a hoarse voice, coughing, or shortness of breath.
Stimulation Deep Inside the Brain
- Surgeons implant electrodes in a part of the brain called the thalamus.
- A generator in the chest sends regular signals to the electrodes.
- Doctors often choose this method when medicines do not work well enough.
Seizure-Responsive Devices
- Doctors call these responsive neurostimulators.
- They place the device in the skull and connect it to the brain.
- The device checks brain activity and sends small electric pulses when it detects a seizure coming.
- This may reduce seizures and improve life for people who do not respond well to other treatments.

Special High-Fat Diet

A high-fat, low-carbohydrate diet—called the ketogenic diet—can help reduce seizures for children and adults. This diet changes the way the body gets energy, making it burn fat instead of carbs. Why this diet may help:

It changes chemicals in the body and brain.
It may help brain cells work differently to stop seizures.

Steps for the Ketogenic Diet

Follow the diet with close medical supervision.
Make sure the food plan includes all needed nutrients.

Other Similar Diets

Low-glycemic index diet
Modified Atkins diet

These diets are not as strict but may also help control seizures.

Diet Challenges and Risks

The diet can be hard to stick with.
It may cause dehydration or constipation.
If not supervised, it could slow growth in children.
It might raise uric acid in the blood, increasing the risk for kidney stones.

Reminder: Always check with a doctor or dietitian before starting the ketogenic diet, especially for children.

Research and Emerging Methods

Scientists keep searching for better ways to treat epilepsy. Some new ideas include:

Ongoing low-level brain stimulation. This sends gentle, regular signals to the part of the brain where seizures begin. The signals are too mild to feel but may stop seizures before they start.
Improved versions of current stimulation devices. Future devices may become smaller, more accurate, or use less battery power.
Targeted medications or biologic therapies. Researchers are working on drugs or genetic treatments designed for specific types of epilepsy.

Table: Ideas for the Future

Possible New Approach	What It Does	Who Might Benefit
Subthreshold Stimulation	Gently stops seizures before symptoms.	People not helped by current treatments.
Gene-Based Therapies	Addresses the root genetic cause.	People with genetic epilepsy.
Smart Device Improvements	Enhance current devices.	Those using implanted therapies.

Not all emerging treatments are available yet. Clinical trials are testing the safety and effectiveness of these methods.

Seizure Regulation Devices Similar to Pacemakers

A neurostimulator can function like a pacemaker for the brain. This device monitors brain activity and responds when it detects patterns that suggest a seizure is about to happen.

It sends a small electrical signal to help prevent the seizure. The main goal is to reduce how often seizures occur. Doctors usually place the device under the scalp and connect it to brain tissue. The device works automatically and does not require daily action.

People may still need to take seizure medicine. Most people report only mild side effects, if any. Doctors usually consider this option for those who do not improve enough with medicine, diet, or other brain stimulation.

Lifestyle and Home Steps

People with epilepsy can better manage their condition by making healthy lifestyle choices. Taking medication as prescribed is important. They should not change their dosage or schedule without guidance from a healthcare professional. Getting enough sleep each night helps lower the risk of seizures.

Wearing a medical alert bracelet makes it easier for emergency staff to provide the right care. Regular exercise supports both physical and mental health, but it is important to stay hydrated and take breaks as needed.

Other helpful habits:

Limiting alcohol
Not smoking
Managing daily stress

Helpful Habits	Why It’s Important
Take medicine on time.	Keeps seizures under better control.
Sleep well.	Reduces seizure risk.
Exercise safely.	Supports body and mood.
Wear an alert bracelet.	Aids emergency treatment.
Avoid triggers.	Helps reduce seizure frequency.

Ways to Manage and Find Help

Dealing with seizures can be stressful and may affect mood, self-confidence, and relationships. Learning more about epilepsy and sharing what you learn helps reduce fear and misunderstandings among family and friends.

Clear facts can push away myths and make daily life easier. Staying as independent as possible is important. Keeping a job or finding new ways to work, such as from home, helps maintain self-worth.

If driving is not an option, public transportation or moving closer to these services can make life more manageable. A strong relationship with a healthcare professional is key.

Feeling comfortable with your doctor lets you talk openly about your worries and get support. Many people also benefit from joining epilepsy support groups. These groups offer advice, shared stories, and emotional encouragement.

Practical Tips:

Choose friends and supporters who understand epilepsy.
Speak up about your needs.
Bring humor into tough moments, when possible.
Do not let fear of seizures control your choices.

To keep everyone safe during a seizure, teach others what to do. Here is a simple table with quick tips for those around someone with epilepsy:

What to Do During a Seizure	What Not to Do
Gently roll the person to one side.	Do not insert anything in the person’s mouth.
Place a soft item under the head.	Do not hold them down.
Loosen tight clothing around the neck.	Do not panic.
Clear away harmful or sharp objects.
Stay with the person and remain calm.
Time the seizure and observe closely.

Support from the workplace and community is important. People with epilepsy can let coworkers and housemates know what to do in case of an emergency. This builds safety and trust. Simple actions and strong support allow people with epilepsy to take part in daily life with confidence.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Preparing well makes an appointment with a neurologist or epilepsy specialist more useful. Here are some important things to do before your visit:

Track Seizures in a Calendar: Write down each time a seizure happens. Include the day, time, how long it lasted, what kind of seizure it was, and if anything may have triggered it. Some possible triggers to note:
- Missed medicines
- Not enough sleep
- Extra stress
- Menstruation
- Illness or infections
Ask About Pre-Visit Instructions: When making the appointment, find out if you need to follow any special rules, such as not eating or drinking before tests.
Record Important Personal Information: Note major stresses or changes in your life. This can help your specialist find any connections to your seizures.
List Your Medications and Supplements: Write down all medicines, vitamins, or herbal supplements you take.
Bring Someone with You: Bring a family member or friend to your appointment. They may notice things about your seizures that you do not remember or help you keep track of the doctor’s advice.
Prepare Questions to Ask: Bring a written list so nothing is forgotten. Here is a sample table for possible questions.

Topic	Example Question
Cause of seizures	What could be causing my seizures?
Testing	What kind of tests should I expect?
Duration of epilepsy	Is this condition likely to be temporary or permanent?
Treatments	What treatment options do you suggest?
Safety	How can I stay safe if I have another seizure?
Managing other health issues	How can I handle my other medical problems?
Medications and alternatives	Is there a generic version of the prescribed medication?
Additional resources	Where can I find more information?

It is alright to ask new questions during the appointment if something is unclear.

What the Specialist May Ask You

Neurologists and epilepsy experts want detailed information. They may ask questions like these:

When did your seizures start?
How often do they happen?
What are you doing when a seizure starts?
Do you notice any warning signs, like strange feelings or sensations?
Are there triggers, such as stress, lack of sleep, or illness?
Are there things that seem to make seizures better or worse?
What symptoms do you notice during a seizure?

You may also need to share your medical history, any family history of seizures, and current medications. Be ready to answer as completely as you can.

Steps to Take While Waiting for the Visit

While you wait for your appointment, you can take steps to help your condition or give your doctor better information.

Limit alcohol and don’t use tobacco. Alcohol and tobacco can raise your risk of having a seizure.
Regular sleep. Try to get enough sleep each night. Sleep loss can trigger seizures in some people.
Watch your stress. Stress can make seizures more likely, so try to reduce stress if you can.
Keep recording seizure activity. Update your seizure calendar and write down any new details.

These steps help you track patterns and avoid possible triggers. You can also give your neurologist useful information during your visit.

Epilepsy – Diagnosis and Treatment