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Friday, May 14th

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Diagnosis of Epilepsy

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Epilepsy is essentially a clinical diagnosis i.e. from history and physical examination. Detailed account of the attack from patient and the eyewitness is more important than the results of all the investigations as regards confirmation of the diagnosis. It often gives clues to the basic cause as well. Thus every effort must be made to obtain this.

Investigations are done to confirm the diagnosis and determine the cause. Depending on the age of the onset of the first seizures and associated symptoms and signs, the doctor decides the number and priority of the investigations. They include:
  • Plain X–rays of skull and chest.
  • Blood count and haemoglobin concentration.
  • Electroencephalogram (EEG).
  • Cerebrospinal Fluid Examination obtained through lumbar puncture.
  • CT Scans and MRI Scans of the brain.
  • Angiography.
  • IQ test and personality tests.
Diagnosing a case of epilepsy
A patient’s detailed medical history is of utmost importance in diagnosing epilepsy. Many times family members who witness the seizure activity might be asked to keep a record of the time of the seizures, how long each seizure lasts, any aggravating factors like emotional stress, certain foods, smells or sounds etc.. This information can be crucial in the diagnosis of the type of epilepsy.

Usually, a neurologist would look into a case of epilepsy, although general physicians can also treat a person with seizures. The laboratory that would be required for epilepsy are:
  • Primary care investigations
    Chest X–ray to rule out malignancy. Blood tests (eg. full blood count, erythrocyte sedimentation rate, electrolytes, renal function, liver function, calcium, and glucose) could show an underlying disorder or metabolic disturbance.
  • Secondary care investigations
    Such as electroencephalography, neuroimaging, and metabolic screening in children, may aid seizure classification and help to determine the aetiology but they have limitations.
  • Magnetic resonance imaging (MRI)

    Can better define the structures of the brain in three dimensions and can look at discrete areas of brain activation.
  • Computed axial tomography (CAT)
    Has a role in the urgent assessment of seizures or when MRI is contraindicated, but it is less effective in detecting lesions.
  • Electroencephalography (EEG)
    The EEG is not foolproof. It can only measure abnormal electrical activity that occurs during the test period and should not be performed to ‘Exclude’ a diagnosis of epilepsy but should be used to support the classification of epileptic seizures and epilepsy syndromes when there is clinical doubt.
  • Positron emission tomography (PET)
    Scanning is a highly specialized, expensive and largely unavailable technique that detects cerebral blood flow and metabolism.
  • Single proton emission computerized tomography (SPECT)
    scanning is much cheaper and technically simpler than PET scanning it shows the areas where blood flows through your brain.


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