Diagnosing seizures and the type of epilepsy is like putting the pieces of a puzzle together and includes information from many people and different tests. The first question is to find out if the person had a seizure, then the doctor will want to know the type of seizure or epilepsy syndrome that best explains the event. To do this, more information will be needed, including details of the medical history, blood tests, EEG tests, and brain imaging tests such as CT and MRI scans. This gives information about the electrical activity of the brain, what the brain looks like and possible causes of seizures. This information is put together with how the individual is feeling and how the seizures may be affecting the way the brain works.
This section takes you through each step in the diagnostic process. The timing of each step will depend on what is going on with each person. Sometimes tests will be repeated and give more accurate information at another time. As new information is obtained, the initial diagnosis may be changed too. It's important to keep in touch with your doctors and health care team and let them know if new problems arise and if your seizures are not responding to treatment. If so, it's time to take another look!
Why See a Doctor?
It is extremely important for anyone who has had a seizure to see a doctor. Even people who have not had a big, obvious seizure should see a doctor if they suspect (or people tell them) that there are periods during which they are not aware of what they're doing.
The doctor will try to determine whether a seizure has occurred. If so, was it caused by some medical condition (diabetes, for instance) that may need treatment? Or is the problem epilepsy? If it's epilepsy, more tests may be needed and usually medicines will be prescribed to prevent further seizures.
What Kind of Doctor is Best?
A person who suspects a problem but doesn't know what it is should go to a primary care doctor (pediatrician, internist, or family physician) first for evaluation. The primary care doctor may run some tests. If the doctor suspects seizures, the person probably will be referred to a neurologist, a doctor with special training in disorders of the brain, including epilepsy. Some neurologists have specific training in epilepsy and spend most of their time treating people with this disorder; they are called epileptologists. For routine treatment of epilepsy, it is usually not necessary to see an epileptologist. A consultation may be beneficial in certain circumstances, such as counseling about pregnancy and childbirth.
A person who has a big seizure is often taken by ambulance to the Emergency Room. There they are seen by an emergency physician, or possibly a neurologist, and will be referred to a neurologist for follow-up.
What Will the Doctor Do?
The first and most important part of a visit to the doctor is an interview, called taking a history. The doctor will ask for a complete description of what happened. Often it is important to bring along a family member or someone else who saw the seizure and can tell the doctor what happened, since the person who had the spell may have been unconscious. Even if the person thinks that he or she was aware, there may be important aspects of the spell that are not recalled. The doctor will want to hear not only a description of the seizure itself, but also the story of the events leading up to it and the after-effects that followed it.
The doctor then will thoroughly examine the person and probably will order several tests. The doctor may have enough information on the first visit for treatment to be recommended and started, but sometimes this will happen only after further test results are reviewed.
|Questions your doctor may ask:
Could the episode have been provoked by sleep deprivation, excessive use of alcohol or drugs, or some other factor?
What was the setting?
Did the episode occur shortly after standing?
Was there a warning?
Exactly what happened during the episode?
How long did it last?
Was the person tired or confused after the episode?
Has there been more than one episode? If so, were they all alike?
Has the person seen a doctor before about this kind of event?
If so, what tests were done?
Was any medication prescribed? What effect did it have?
What Tests Are Needed?
The doctor usually orders a variety of tests to help make the diagnosis. These include:
1. A brain wave test, also called an EEG (electroencephalogram), to look for changes in the brain's electrical patterns that are related to seizure.
2. Blood tests, to look for certain medical disorders
3. Either a special x-ray of the brain, a CT scan (sometimes called a CAT scan), or an MRI scan (magnetic resonance imaging), to look for abnormal areas such as a tumor or infection.
Depending on the urgency of the situation, other tests also might be recommended, such as a lumbar puncture (also called a spinal tap), EKG (electrocardiogram, to check the heart), or a sleep test.
The results of these tests often appear completely normal in people with epilepsy. Normal test results do not mean that the seizures are not real or that epilepsy is not present.
What If It's Not Epilepsy?
After looking at the test results, the doctor (and perhaps some other specialists) may conclude that the person has a medical or psychological condition that causes events that look like epileptic seizures. In that case, treating that condition (instead of giving seizure medicines) may prevent future incidents.
On the other hand, all the test results might be normal. Then the doctor has to determine whether treatment is needed. Some people have a single seizure and don't have any more. But others go on to have more seizures later, leading to the diagnosis of epilepsy.