Diagnosing Epilepsy

Special Consideration for the Military: Military personnel may underreport mild TBI to avoid removal from combat situations or active duty and therefore may automatically be under diagnosed.  Also, limited time and resources available at forward medical commands can prohibit thorough TBI evaluation, which results in service members returning to duty with symptoms of an undiagnosed TBI. Diagnosing epilepsy is a multi-step process, usually involving the following evaluations:

• Confirming through patient history, neurological exams, and supporting blood and other clinical tests – that the patient has epileptic seizures and not some other type of episode, such as fainting, transient ischemic attacks, hypoglycemia or non-epileptic seizures.

• Identifying the type of seizure involved.

• Performing a clinical evaluation in search of the cause of the epilepsy.

• Selecting the most appropriate therapy based on all previous findings.

Doctor’s Investigation

If you’ve had a seizure, your doctor will look to answer these questions 

• Was the seizure caused by a short-term problem (like fever or infection) that can be corrected?

• Was it caused by a continuing problem in the way your brain’s electrical system works?

• Is there anything about the structure of your brain that could cause seizures?

• Was the seizure an isolated event, or does it mean that you have epilepsy?

Diagnostic Methods and Tools

The doctor’s main tool in diagnosing epilepsy is a careful medical history with as much information as possible about what the seizures look like and what happened just before they began. The doctor will also perform a thorough physical examination, especially of the nervous system.

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Other Diagnostic Tools

An electroencephalograph (EEG) is a machine that records brain waves picked up by tiny wires taped to the head.  Electrical signals from brain cells are recorded as wavy lines by the machine.  Brain waves during or between seizures may show special patterns that can help the doctor decide whether or not someone has epilepsy, or is at risk for epileptic seizures.  A normal baseline EEG does not rule out the possibility of an underlying epileptic disorder.  Imaging methods such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans may be used to search for any growths, scars, or other physical conditions in the brain that may be causing the seizures.  There are numerous other tests that can be performed to analyze the area of the brain causing seizures, but most of these are only done when a patient is being evaluated for possible epilepsy surgery.  Which tests and how many are ordered vary, depending on how much each test reveals.

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Treatment Options

Treating epilepsy involves many different people. The team may include your primary care doctor, nurse, psychologist or social worker, and specialists such as a neurologist. You may want to bring along a family member or friend to help describe your seizures or to take notes during visits to your doctor. Once the doctor has made a diagnosis of seizures or epilepsy, the next step is to select the best form of treatment. If epilepsy – that is, a continuing tendency to have seizures – is diagnosed, the doctor will usually prescribe regular use of seizure-preventing drugs. If drugs are not successful, other methods are considered, including surgery, a special diet or vagus nerve stimulation (VNS). The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for people to lead active lives.

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Medication

Medications do not cure epilepsy but, for many, the medication will prevent seizures as long as they are taken regularly.  Most epilepsy medicines are taken by mouth.  The doctor’s and patient’s choice of which drug to consider depends on what kind of seizure a person is having.  Other factors include patient’s age, other medications, other medical problems, allergies and potential side effects of the medication. Some people experience side effects, while others may not.  It may take some time to find exactly the right dose of the right drug.  It is reported that antiepileptic drugs provide complete control for more than half of all patients with epilepsy, and significantly reduce the number of seizures in another 20-30 percent.  The remaining 20 percent do not respond to current medications and must look at other treatment options.

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Surgery

When antiepileptic drugs fail to control or substantially reduce seizures, brain surgery may be considered.  Surgical removal of seizure-producing areas of the brain has been an accepted form of treatment for more than 50 years.  Some seizure medications may have to be continued, usually for a year or two.  Then, if no further seizures occur, the medicine may be slowly withdrawn.  At this point, chances of living free of seizures and free of medication are good.  However, many people will have to continue with medication and some do not benefit significantly from surgery.
 

Vagus Nerve Stimulation (VNS)

VNS is a type of treatment in which short bursts of electrical energy are directed into the brain via the vagus nerve, a large nerve in the neck which connects to the brainstem. The energy comes from a battery, about the size of a silver dollar, which is surgically implanted under the skin, usually on the left side of the chest.  Although complete seizure control is rarely achieved, the majority of people who use VNS therapy experience fewer seizures. In some, its effectiveness increases with time, and patients report an improved quality of life. It will almost always be necessary to continue antiepileptic medication, although the patient could be on less medication than before.