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To make a diagnosis of epilepsy, it is necessary for a doctor to establish that a person has recurrent, spontaneous epileptic seizures. Many people have a single, isolated seizure at some point in their lives, but if a person has more than one, then a diagnosis of epilepsy may well be considered. The classical tonic-clonic (Grand Mal) seizure is probably easier to diagnose, but epilepsy can manifest itself in many ways.
Epileptic seizures are caused by intermittent and temporary disturbances to the electrical impulses in the brain, which can produce:
- Disturbance of consciousness or awareness, and/or
- Affect bodily movement, sensation or posture.
More often than not, the person concerned will have no recollection of what has actually happened. For this reason, it is very important for someone else, i.e. a parent or spouse, to discuss the seizure with the person’s doctor, who may be their GP, a hospital doctor or consultant neurologist.
Seeing an epileptic seizure for the first time can be a frightening experience. Nevertheless, it is very important for a witness to remember and describe accurately all the events surrounding the seizure and the details of the seizure itself.
The doctor is heavily dependent on an accurate eye-witness account of the events surrounding the seizure and the seizure itself, which may be the only information on which the diagnosis rests. If there is a videotape of the episode this may help, but do obtain the person’s consent in advance of making any such recording.
Once the doctor has the basic information about the events surrounding the seizure, other important questions will be discussed:
- Has the person really had a seizure, or is there some other explanation for the events that occurred?
- Was the seizure due to disturbance within the brain, or was it due to some other cause?
- Has the person only had one seizure, or have other seizures occurred in the past?
If the doctor is satisfied that the events were epileptic seizures then the next question to consider is whether there is an identifiable cause within the brain itself, such as a tumour, which itself is treatable? To help answer this, tests such as brain scans may be arranged. These are designed to help confirm diagnosis, and also to determine any identifiable cause of the epilepsy. The tests do not always make a diagnosis of epilepsy; this remains a clinical decision based on what happened to the person.
Tests and investigations
Blood tests
These check the general health of the person and help to rule out abnormal amounts of various substances in the body as a possible cause for the seizure.
Brain scans
These help to exclude a structural cause for the seizures. CT or MRI scans of the brain may be requested and in many people such tests will be normal.
Electroencephalogram(EEG)
This test measures the electrical activity of the surface of the brain. Electrodes are placed on the scalp and the signals picked up are amplified and recorded onto paper. It is a painless procedure lasting about 30 minutes. It should be remembered that the EEG can only give information about the electrical activity of the brain during the period of the recording. Only if patterns characteristic of epilepsy are seen during the routine recording is the EEG of value on the diagnosis. Therefore, a negative EEG does not exclude the possibility of epilepsy.
Sometimes, longer term EEG (ambulatory EEG) may be necessary. The person wears a small pack containing an audio cassette tape around their waist, with wires underneath their clothing, attached to their head. EEG monitoring can then take place over a number of days and the person can carry on with their normal activities.
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