Diagnosis

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When health care professionals use the term "epilepsy," they are referring to a medical condition that involves two or more spontaneously recurrent seizures. The term "seizure" refers to the event. In other words, not all seizures are epilepsy.

Accurate diagnosis of epilepsy requires a detailed medical history and a battery of tests that provide a comprehensive picture of the brain. Developmental, neurological and behavioral assessments are performed.

To assist the health care team in making a diagnosis, you may be asked to keep a detailed seizure diary. This type of record keeping also may be recommended as a lifelong management strategy to help record how medication and other factors affect seizure activity.

A seizure diary could include the following information (some of which may need to be recorded by a family member or partner):

• Date and time the seizure occurred.

• A detailed description of the seizure, including length of the seizure and your symptoms. Be specific. Note what you were doing when the seizure occurred.

• Record all medications taken, including both over-the-counter and prescribed, as well as the dose and time taken. Be sure to include a note about your last dose of antiepileptic medication (if you are currently taking any). Record if you skipped or changed your dosage, whether by accident or with the guidance of your health care professional.

• Describe the food and beverage you consumed within the 24 hours prior to the seizure, as well as the time you ate or drank.

• Record information about your menstrual period.

• Describe how you were feeling and the events or situations that you experienced within the two to three days before your seizure. (Be sure to note your sleeping habits, daily activities and general health.)

In addition to taking a detailed medical history, your health care professional may order blood tests to check on your general health and to determine if you have an infection, genetic disorder or vitamin deficiency or if you've been exposed to any poisons, such as lead. If your health care professional suspects your seizure may be caused by an infection or bleeding in the brain, he or she may perform brain imaging or a spinal tap, in which a small amount of fluid is taken from your spinal canal to be tested.

Other important tests involve recording your brain's activity:

• Electroencephalogram (EEG). This painless test records the electrical activity in your brain to see if there are any irregularities. Small electrodes are pasted to your head and connected to a computer to record the electrical activity. Abnormal brain activity patterns may indicate epilepsy. You may have the test, which lasts for about one to two hours, at a hospital or doctor's office. A normal EEG doesn't rule out epilepsy, and you may need to have an EEG more than once before a diagnosis is made. Sometimes, the health care professional may ask that you do not sleep the night before the test or awaken early to enhance the chance of seeing an abnormality.

• Brain imaging. There are a variety of tests, similar to x-rays, that help your health care professional examine your brain. Magnetic resonance imaging (MRI) scans, computed tomography (CT) scans and positron emission tomography (PET) scans are three imaging techniques used to view the brain. All three types of imaging may or may not be necessary in the evaluation of your epilepsy. Typically, you'll be asked to lie on a table and the MRI, CT or PET machine will be moved over your head to scan your brain. These procedures are painless. You may have an injection of a substance that makes the scan easier to read. After the injection, some people say they experience a metallic taste in the mouth, feel flushed or have brief nausea.

Other tests may be performed to measure your motor abilities, behavior and intellectual capacity to evaluate how the disorder is affecting you.