Epilepsy - Diagnosis and treatment (2023)

Diagnosis

Diagnosis of your condition

To diagnose your condition, your healthcare provider will likely review your symptoms and medical history. You may have several tests to diagnose epilepsy and to find the cause of seizures. Your assessment may include:

• Neurological examination.This test checks your behavior, motor skills, mental function, and other areas to diagnose your condition and determine the type of epilepsy you may have.
• BLOOD TESTS.A blood sample can detect signs of infections, genetic conditions, or other conditions that may be associated with seizures.

• Genetic test.In some people with epilepsy, genetic testing can provide more information about the condition and how to treat it. Genetic testing is most often done in children, but may also be helpful in some adults with epilepsy.

You may also have one or more brain imaging tests and scans that detect brain changes:

• Electroencephalogram (EEG).This is the most common test used to diagnose epilepsy. In this test, electrodes are attached to your scalp with a paste-like substance or cap. The electrodes record your brain's electrical activity.

  If you have epilepsy, it's common to have changes in the typical pattern of your brain waves. These changes happen even when you don't have a seizure. Your health care provider can watch you on video during a sessionEEGto identify and record any crises you experience. This can be done while you are awake or asleep. Recording your seizures can help you determine what type of seizures you're having or rule out other conditions.

  The test can be done in a health care provider's office or hospital. If necessary, you can also have a walkerEEG, which you wear at home while theEEGrecords seizure activity over the course of a few days.

  You may be instructed to do something that may trigger seizures, such as getting some sleep before the test.

• High densityEEG.In a variant of anEEGtest, you may have high densityEEG, which places the electrodes closer than conventional onesEEG. High densityEEGcan help you determine more precisely which areas of your brain are affected by seizures.
• Computed tomography (CT).ONECTThe scan uses X-rays to take cross-sectional images of your brain.CTScans can detect tumours, bleeding or cysts in the brain which may be causing epilepsy.
• Magnetic resonance imaging (MRI).OneMRIuses powerful magnets and radio waves to create a detailed image of the brain. As aCTscan, anMRIexamines the structure of the brain to detect what may be causing seizures. But oneMRIprovides a more detailed look at the brain than aCTscan.
• OperatingMRI(fMRI).A functional oneMRIit measures the changes in blood flow that occur when specific parts of the brain are working. This test can be used before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring these areas during surgery.
• Positron emission tomography (PET). PETThe scans use a small amount of low-dose radioactive material injected into a vein to help visualize the brain's metabolic activity and detect changes. Areas of the brain with low metabolism may indicate sites where seizures occur.

• Single photon emission electron tomography (SPECT).This type of test is mainly used ifMRIandEEGhe did not pinpoint the location in the brain from which the seizures originate.

  ONESPECTThe test uses a small amount of low-dose radioactive material injected into a vein to create a detailed, three-dimensional map of blood flow activity in the brain during seizures. Areas of higher than typical blood flow during a seizure may indicate places where seizures are occurring.

  Another guySPECTtest called ictal subtractionSPECTco-registered toMRI(SISCOM) can provide even more detailed results by overlaying itSPECTresults with the brainMRIResults.

• Neuropsychological tests.These tests assess thinking, memory and speaking skills. Test results help determine which areas of the brain are affected by seizures.

Along with your test results, a combination of analysis techniques can be used to identify where seizures start in the brain:

• Statistical parametric mapping (SPM). SPMis a method of comparing areas of the brain that have increased blood flow during seizures with the same areas of the brain in people who do not have seizures. This provides information about where the seizures start.
• Electrical source imaging (ESI). ESIit's a technique that takesEEGdata and displays it in aMRIof the brain to show the areas where seizures occur. This technique provides more detail thanEEGsingle.
• Magnetoencephalography (MEG). MEGmeasures magnetic fields produced by brain activity. This helps identify potential areas where seizures start.MEGmay be more accurate thanEEGbecause the skull and the tissues surrounding the brain interfere less with magnetic fields than with electrical impulses.MEGandMRItogether they provide images showing areas of the brain affected by seizures and unaffected by seizures.

Accurately diagnosing the type of seizures and where the seizures start gives you the best chance of finding an effective treatment.

Treatment

Treatment can help people diagnosed with epilepsy have fewer seizures or even stop having seizures altogether. Possible treatments include:

• Medicines.
• Surgery.
• Treatments that stimulate the brain using a device.
• A ketogenic diet.

Medication

Most people with epilepsy can get rid of seizures by taking an anticonvulsant drug, also called an anticonvulsant drug. Others may be able to reduce the frequency and intensity of their seizures by taking a combination of medications.

Many children with epilepsy who do not have epilepsy symptoms are eventually able to stop the medication and live a seizure-free life. Many adults can stop the drugs after two or more years without seizures. Your healthcare team can advise you about the right time to stop taking medication.

Finding the right medication and dosage can be complicated. Your provider may consider your condition, seizure frequency, age, and other factors when choosing which drug to prescribe. Your provider may also look at any other medications you may be taking to make sure the antiseizure medications won't interact with them.

You can take a single drug at a relatively low dose first and then increase the dose gradually until your seizures are well controlled.

There are more than 20 different types of anticonvulsant drugs available. The medicines you take to treat your epilepsy depend on the type of seizures you have, as well as other factors such as your age and other health conditions.

These drugs may have some side effects. Mild side effects include:

• Fatigue.
• Dizziness.
• Weight gain.
• Loss of bone density.
• Skin rashes.
• Loss of coordination.
• Speech problems.
• Memory and thinking problems.

More serious but rare side effects include:

• Depression.
• Suicidal thoughts and behaviors.
• Severe rash.
• Inflammation of certain organs, such as the liver.

To achieve the best possible seizure control with the drug, follow these steps:

• You take the medicines exactly as prescribed.
• Always call your health care provider before switching to a generic version of your medication or taking other medications — those you get with or without a prescription — or herbal remedies.
• Never stop taking your medicine without talking to your healthcare provider.
• Tell your healthcare provider right away if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behavior.
• Tell your healthcare provider if you have migraines. Your provider may prescribe one of the antiepileptic drugs that can prevent your migraines and treat epilepsy.

At least half of people newly diagnosed with epilepsy do not have seizures with their first drug. If anti-seizure medications do not provide good results, you may be able to undergo surgery or other treatments. You will likely have regular follow-up appointments with your healthcare provider to evaluate your condition and medications.

Surgery

Epilepsy surgery

When medications do not provide adequate seizure control,epilepsy surgerymay be an option. With epilepsy surgery, a surgeon removes the area of ​​your brain that causes seizures.

Surgery usually happens when tests show that:

• Your judgments come from a small, well-defined area of ​​your brain.
• The area of ​​your brain to be operated on does not interfere with vital functions such as speech, language, motor function, vision or hearing.

For certain types of epilepsy, minimally invasive approaches such asMRI-Guided stereotactic laser ablation can provide effective treatment when an open procedure may be too risky. In these procedures, a thermal laser probe is directed at the specific area of ​​the brain causing seizures to destroy that tissue in an attempt to better control the seizures.

Although you may still need some medication to prevent seizures after successful surgery, you may be able to take less medication and lower your doses.

In a small number of people, surgery for epilepsy can cause complications such as permanently changing thinking abilities. Talk to members of your surgical team about their experience, success rates, and complication rates with the procedure you're considering.

Treatments

In addition to drugs and surgery, these potential treatments offer an alternative for treating epilepsy:

• Vagus nerve stimulation.Vagus nerve stimulation may be an option when medications have not worked well enough to control seizures and surgery is not possible. In vagus nerve stimulation, a device called a vagus nerve stimulator is implanted under the skin of the chest, similar to a heart pacemaker. Wires from the stimulator connect to the vagus nerve in the neck.

  The battery-operated device sends bursts of electrical energy through the vagus nerve and into the brain. It's not clear how this stops seizures, but the device can typically reduce seizures by 20% to 40%.

  Most people still need to take anti-seizure medication, although some people may be able to reduce the dose of their medication. Side effects of vagus nerve stimulation may include a sore throat, hoarse voice, shortness of breath, or cough.

• Deep brain stimulation.In deep brain stimulation, surgeons implant electrodes in a specific part of the brain, usually the thalamus. The electrodes are connected to a generator implanted in the chest. The generator sends regular electrical pulses to the brain at set intervals and can reduce seizures. Deep brain stimulation is often used for people whose seizures do not improve with medication.
• Responsive neurostimulation.These implantable pacemaker-like devices can greatly help reduce the incidence of seizures. These responsive stimulation devices analyze patterns of brain activity to detect seizures as they begin and deliver an electrical charge or drug to stop the seizure before it causes damage. Research shows that this treatment has few side effects and can provide long-term relief from seizures.

Ketogenic diet

Some children and adults with epilepsy have been able to reduce their seizures by following a strict high-fat, low-carbohydrate diet. This may be an option when medications do not help control epilepsy.

In this diet, called the ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet—under the close supervision of their health care providers—and remain seizure-free.

Experts don't fully know how a ketogenic diet works to reduce seizures. But researchers believe the diet creates chemical changes that suppress seizures. The diet also changes how brain cells work to reduce seizures.

Get medical advice if you or your child are considering a ketogenic diet. It is important to make sure your child is not malnourished when following the diet.

Side effects of a ketogenic diet can include dehydration, constipation, stunted growth due to nutritional deficiencies, and a build-up of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically controlled.

The ketogenic diet can be a challenge. Low-glycemic diets and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control.

Possible future treatments

Researchers are studying many potential new treatments for epilepsy, including:

• Continuous stimulation of the seizure initiation zone, known as subthreshold stimulation.Subthreshold stimulation — continuous stimulation of an area of ​​the brain below a level that is physically noticeable — appears to improve seizure outcomes and quality of life for some people with seizures. Subthreshold stimulation helps stop a seizure before it happens. This treatment approach may work in people who have seizures that begin in an area of ​​the brain called the eloquent area that cannot be removed because it will affect speech and motor functions. Or it may benefit people whose seizure characteristics mean that the chances of successful treatment with responsive neurostimulation are low.
• Minimally invasive surgery.New minimally invasive surgical techniques, such asMRI-Guided focused ultrasound, promises to treat epileptic seizures. These surgeries have fewer risks than traditional open brain surgeries for epilepsy.
• Transcranial magnetic stimulation (TMS). TMSapplies focused magnetic fields to areas of the brain where seizures occur to treat seizures without the need for surgery. It can be used in patients whose seizures occur near the surface of the brain and cannot be treated with surgery.
• External trigeminal nerve stimulation.Similar to vagus nerve stimulation, a device stimulates specific nerves to reduce the frequency of seizures. But unlike vagus nerve stimulation, the device is worn outside the body, so no surgery is required to place the device in the body. In studies, external stimulation of the trigeminal nerve provided improvements in both seizure control and mood.

Clinical tests

Explore the Mayo Clinic studiestesting new treatments, interventions and tests as a means of preventing, detecting, treating or managing this condition.

Lifestyle and home remedies

Understanding your condition can help you better control it:

• Take your medicine correctly.Do not adjust your dose before talking to a member of your healthcare team. If you think your medication needs to be changed, discuss it with your provider.
• Sleep enough.Lack of sleep can cause seizures. Make sure you get enough rest every night.
• Wear a medical bracelet.This will help emergency personnel know how to treat you properly.
• Excercise.Exercise can help keep you physically fit and reduce depression. Make sure to drink enough water and rest if you get tired during exercise.

Additionally, make healthy lifestyle choices, such as managing stress, limiting alcoholic beverages, and avoiding cigarettes.

Handling and support

Uncontrollable crises and their impact on your life can at times feel overwhelming or lead to depression. It's important not to let epilepsy hold you back. You can still live an active, full life. To help deal with:

• Educate yourself and your friends and familyabout epilepsy to understand the situation.
• Try to ignore people's negative reactions.It helps to learn about epilepsy so you know the facts as opposed to the misconceptions about the disease. And try to keep your sense of humor.
• Live as independently as possible.Keep working if possible. If you are unable to drive because of your seizures, explore public transportation options near you. If you are not allowed to drive, you may want to consider moving to a city with good public transportation options.
• Find a healthcare provider you likeand who you feel comfortable with.
• Try not to worry all the timefor a seizure.
• Find an epilepsy support groupto meet people who understand what you are going through.

If your seizures are so severe that you can't work outside of your home, there are still ways to feel productive and connected to people. You can consider working from home.

Let the people you work and live with know the right way to deal with a crisis in case they are with you when you have one. You can make suggestions to them, such as:

• Carefully roll the person to one side to prevent suffocation.
• Place something soft under the person's head.
• Relax a tight neck.
• Do not try to put your fingers or anything else in the person's mouth. People with epilepsy will not "swallow" their tongue during a seizure — it's physically impossible.
• Do not try to restrain someone who is having a seizure.
• If the person is moving, remove the hazardous objects.
• If immediate medical attention is needed, stay with the person until medical personnel arrive.
• Observe the person carefully so that you can provide details of what happened.
• Time the crises.
• Stay calm during seizures.

Preparing for your appointment

You are likely to start with your primary care provider. However, when you call to make an appointment, you may be immediately referred to a specialist. This specialist may be a doctor trained in diseases of the brain and nervous system, known as a neurologist, or a neurologist trained in epilepsy, known as an epileptologist.

Because dates can be short and because there's often a lot to talk about, it's a good idea to be well prepared for your date. Here is some information to help you prepare for your appointment and what to expect.

What can you do

• Keep a detailed crisis diary.Each time a seizure occurs, note the time, the type of seizure you experienced, and how long it lasted. Also note any conditions, such as missed medications, sleep deprivation, increased stress, menstruation, or other events that may trigger seizures.

  Ask people who may notice your seizures, including family, friends, and colleagues, to record information you may not know.

• Be aware of any restrictions before the appointment.At the time of your appointment, ask if there is anything you need to do beforehand, such as restricting your diet.
• Record basic personal information,including any major stressors or recent life changes.
• Make a list of all medications,vitamins or supplements you take.

• Take a family member or friend along.Sometimes it can be difficult to remember all the information you are given during an appointment. Someone accompanying you may remember something you lost or forgot.

  Also, because you may not know everything that happens when you have a seizure, someone else who has seen your seizures may be able to answer questions during your appointment.

• Write questions to askyour health care provider. Preparing a list of questions will help you get the most out of your appointment time.

For epilepsy, some key questions include:

• What is likely to be causing my seizures?
• What kind of tests do I need?
• Is my epilepsy likely to be temporary or chronic?
• What treatment approach do you recommend?
• What are the alternatives to the mainstream approach that you suggest?
• How can I make sure I don't hurt myself if I have another seizure?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions I need to follow?
• Should I see a specialist? What will this cost and will my insurance cover it?
• Is there a generic alternative to your prescription drug?
• Are there brochures or other printed material I can take home with me? What sites do you recommend?

In addition to the questions you have prepared, feel free to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor

Your healthcare provider is likely to ask you a number of questions, including:

• When did you first start having seizures?
• Do your seizures seem to be triggered by certain events or situations?
• Do you have similar sensations just before the onset of a seizure?
• Were your seizures frequent or occasional?
• What symptoms do you have when you have seizures?
• What, if anything, seems to improve your judgments?
• What, if anything, seems to make your judgments worse?

What can you do in the meantime?

Certain situations and activities can trigger seizures, so it may be helpful to:

• Avoid drinking excessive amounts of alcohol.
• Avoid using nicotine.
• Sleep enough.
• Reduce stress.

It's also important to start keeping a seizure log before your appointment.