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Tests and diagnosis
By Mayo Clinic staffYour doctor may use a number of tests to diagnose epilepsy, from neurological exams to imaging techniques like MRI scans.
- Neurological and behavioral exam. Your doctor may want to test your motor abilities, behavior and intellectual capacity to see how the seizures are affecting you.
- Blood tests. Your doctor may take a blood sample to check for signs of infections, lead poisoning, anemia or diabetes, which can cause seizures.
Your doctor may also suggest tests to detect abnormalities within the brain. These include:
- Neuropsychological tests. This group of tests includes IQ, memory and speech assessments, which help doctors pinpoint where the seizures are originating. This type of testing is routinely done before epilepsy surgery.
- Electroencephalogram (EEG). This is the most common test to diagnose epilepsy. An EEG records the electrical activity of your brain via electrodes affixed to your scalp. If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may want to monitor you on video while conducting an EEG of you awake or asleep in hopes of recording the seizure to see what kind of seizures you're having. Sometimes your doctor will have to do something to provoke a seizure while you're being tested, such as asking you to sleep very little the night before.
- Computerized tomography (CT). You might be given a CT scan if you go to an emergency room for an initial seizure, because it's generally a readily available test. CT machines use a type of X-ray equipment to obtain cross-sectional images of your brain and skull. CT scans can reveal abnormalities in the brain that might be causing your seizures, including tumors, bleeding and cysts.
- Magnetic resonance imaging (MRI). An MRI provides much the same type of information as a CT scan, but in far greater detail. MRIs use radio waves and a strong magnetic field to produce detailed images of your brain. MRIs can reveal brain abnormalities that could be causing your seizures.
- Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors generally use an fMRI before surgery to identify the exact locations of critical functions, like speech, so that surgeons don't injure those places while operating.
- Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.
- Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating. A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.
References
- Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm. Accessed Feb. 2, 2009.
- Schachter SC, et al. Overview of the management of epilepsy in adults. http://uptodate.com/home/index.html. Accessed Jan. 6, 2009.
- Wilfong A, et al. Overview of the classification, etiology, and clinical features of pediatric seizures and epilepsy. http://uptodate.com/home/index.html. Accessed Jan. 6, 2009.
- Boggs JG. Seizures and epilepsy in the elderly: Etiologies, clinical presentation, and differential diagnosis. http://uptodate.com/home/index.html. Accessed Jan. 6, 2009.
- Information for healthcare professionals: Suicidal behavior and ideation and antiepileptic drugs. U.S. Food and Drug Administration Center for Drug Evaluation and Research. http://www.fda.gov/cder/drug/InfoSheets/HCP/antiepileptics200812.htm. Accessed Feb. 2, 2009.
- Krumholz A, et al. Driving restrictions for patients with seizures and epilepsy. http://uptodate.com/home/index.html. Accessed Jan. 6, 2009.
- Feen ES, et al. Status epilepticus. Southern Medical Journal. 2008;101:400.
- Tomson T, et al. Sudden unexpected death in epilepsy: A review of incidence and risk factors. Epilepsia. 2005;46:54.
- Bell GS, et al. Drowning in people with epilepsy: How great is the risk? Neurology. 2008;71:578.
- First aid. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/firstaid/. Accessed Feb. 2, 2009.
- Law enforcement/EMS response to seizures. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/professionals/emergency/index.cfm. Accessed Feb. 2, 2009.
- Schachter SC, et al. Vagus nerve stimulation therapy. http://uptodate.com/home/index.html. Accessed Jan. 6, 2009.
- Hirsch LJ, et al. Neuroimaging in the evaluation of seizures and epilepsy. http://uptodate.com/home/index.html. Accessed Jan. 6, 2009.
- French JA, et al. Initial management of epilepsy. New England Journal of Medicine. 2008;359:166.
- About epilepsy: Epilepsy fact sheet. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/factsfigures.cfm. Accessed Feb. 2, 2009.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Feb. 2, 2009.
- Living with epilepsy: Tips for living. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/quickstart/newlydiagnosed/qsliving/idvtips.cfm. Accessed Feb. 2, 2009.
- Transportation. Epilepsy Foundation. http://www.epilepsyfoundation.org/living/wellness/transportation/. Accessed March 2, 2009.
- Myoclonus fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/myoclonus/detail_myoclonus.htm#105233160. Accessed March 3, 2009.
- Stroke: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/detail_stroke.htm. Accessed March 3, 2009.
- Browne TR, et al. Handbook of Epilepsy. 4th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:133.
- Cancer imaging. National Cancer Institute. http://imaging.cancer.gov/imaginginformation/cancerimaging/. Accessed March 5, 2009.
- Devinsky O. Epilepsy: Patient and family guide. 3rd ed. New York, N.Y.: Demos Medical Publishing; 2008:81.
- Treatment options: Ketogenic diet. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/treatment/ketogenicdiet/ketoalone.cfm. Accessed March 24, 2009.
- Treatment options: Ketogenic diet. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/treatment/ketogenicdiet/. Accessed March 24, 2009.
- Pre-surgical evaluation. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/treatment/surgery/evaluation.cfm. Accessed March 24, 2009.
- Spencer SS, et al. Multiple subpial transection for intractable partial epilepsy: An international meta-analysis. Epilepsia. 2002;43:141.
- So EL. What is known about the mechanisms underlying SUDEP? Epilepsia. 2008;49:93.
- Neurontin (prescribing information
.). New York, N.Y.: Pfizer Inc.; 2007. http://www.pfizer.com/products/rx/rx_product_neurontin.jsp. Accessed March 24, 2009. - So E (expert opinion). Mayo Clinic, Rochester, Minn. March 24, 2009.
