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Tests and diagnosis
By Mayo Clinic staff
Medical history
Your doctor will need a detailed description of the seizures, preferably from a witness, because most people who have temporal lobe seizures don't remember the episodes.
Neurological exam
If you've had a seizure, your doctor usually will perform a neurological exam that tests:
- Reflexes
- Muscle tone
- Muscle strength
- Sensory function
- Gait
- Posture
- Coordination
- Balance
He or she may also ask questions to assess your thinking, judgment and memory.
Blood tests and scans
Blood tests may be ordered as appropriate to check for problems that could be causing or triggering the seizures.
Your doctor may also suggest scans or tests designed to detect abnormalities within the brain.
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Electroencephalogram (EEG). An EEG displays the electrical activity of your brain as recorded by electrodes attached to your scalp. People with epilepsy often have changes in their brain wave patterns, even when not having a seizure. The EEG sometimes can help indicate the type of seizures you're having.
In some cases, your doctor may recommend video-EEG monitoring in the hospital. This allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern. This can help your doctor pinpoint the type of seizure disorder you have, which helps to identify the most appropriate treatment options, and can help make sure that the diagnosis of seizures is correct.
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Magnetic resonance imaging (MRI). An MRI machine produces detailed images of your brain. Although many people with seizures and epilepsy have normal MRIs, certain MRI abnormalities may provide a clue to the cause of the seizures.
During the test, you will lie on a padded table that slides into the MRI machine. Your head will be immobilized in a brace, to improve precision. The test is painless, but some people experience claustrophobia inside the MRI machine's close quarters. If you think you may have this problem, inform your doctor before the study.
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Single-photon emission computerized tomography (SPECT). This type of test is sometimes used in people being evaluated for epilepsy surgery when the area of seizure onset is unclear on MRIs or EEGs. SPECT imaging requires two scans — one during a seizure and one during a nonseizure period, each performed on separate days. Radioactive material is injected for both scans. The seizure and nonseizure scan are then compared on a computer to see the area of the brain with the greatest activity during the seizure. The resulting image is then superimposed onto the MRI. This is used with EEG information to help guide the surgeons during surgery planning to possible areas of seizure onset.
- Temporal lobe epilepsy. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/types/syndromes/temporallobe.cfm. Accessed March 29, 2011.
- FDA warns about potential Topamox related birth defects. FDA Reports. http://www.fda-reports.com/alerts/?p=187. Accessed March 23, 2011.
- FDA: Aseptic meningitis risk with use of seizure drug Lamactil. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm222212.htm. Accessed March 23, 2011.
- Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence based review): Teratogenesis and perinatal outcomes. St. Paul, Minn.: American Academy of Neurology. http://www.neurology.org/cgi/content/abstract/WNL.0b013e3181a6b312v1. Accessed March 23, 2011.
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- Stafstrom CE, et al. Pathophysiology of seizures and epilepsy. http://www.uptodate.com/index/home.html. Accessed March 22, 2011.
- Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm?css=print. Accessed March 22, 2011.
- Schachter SC. Evaluation of the first seizure in adults. http://www.uptodate.com/index/home.html. Accessed March 22, 2011.
- Seizure disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch214/ch214a.html. March 23, 2011.
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