Question: how is epilepsy diagnosed

Reference:
 Epilepsy Overview Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Epilepsy care at Mayo Clinic Symptoms Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include: - Temporary confusion - A staring spell - Uncontrollable jerking movements of the arms and legs - Loss of consciousness or awareness - Psychic symptoms such as fear, anxiety or deja vu Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode. Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins. Focal seizures When seizures appear to result from abnormal activity in just one area of your brain, they're called focal (partial) seizures. These seizures fall into two categories: - Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don't cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights. - Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles. Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders. Generalized seizures Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist. - Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness. - Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground. - Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down. - Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms. - Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs. - Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. When to see a doctor Seek immediate medical help if any of the following occurs: - The seizure lasts more than five minutes. - Breathing or consciousness doesn't return after the seizure stops. - A second seizure follows immediately. - You have a high fever. - You're experiencing heat exhaustion. - You're pregnant. - You have diabetes. - You've injured yourself during the seizure. If you experience a seizure for the first time, seek medical advice. Causes Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including: - Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures. - Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy. - Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35. - Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy. - Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy. - Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis. Risk factors Certain factors may increase your risk of epilepsy: - Age. The onset of epilepsy is most common in children and older adults, but the condition can occur at any age. - Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder. - Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury. - Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly. - Dementia. Dementia can increase the risk of epilepsy in older adults. - Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk. - Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won't develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy. Diagnosis To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include: - A neurological exam. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have. - Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures. Your doctor may also suggest tests to detect brain abnormalities, such as: - Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain. 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 monitor you on video while conducting an EEG while you're awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you're having or rule out other conditions. Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test. - High-density EEG. In a variation of an EEG test, your doctor may recommend high-density EEG, which spaces electrodes more closely than conventional EEG - about a half a centimeter apart. High-density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures. - Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts. - Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain 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 may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring 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. Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more-detailed results. - Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected. Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start: - Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin. - Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring. - Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset. Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment. Treatment Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment. Medication Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications. Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won't interact with them. Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled. Anti-seizure medications 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-severe but rare side effects include: - Depression - Suicidal thoughts and behaviors - Severe rash - Inflammation of certain organs, such as your liver To achieve the best seizure control possible with medication, follow these steps: - Take medications exactly as prescribed. - Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies. - Never stop taking your medication without talking to your doctor. - Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors. - Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy. At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your doctor to evaluate your condition and medications. Surgery When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that's causing seizures. Doctors usually perform surgery when tests show that: - Your seizures originate in a small, well-defined area of your brain - The area in your brain to be operated on doesn't interfere with vital functions such as speech, language, motor function, vision or hearing Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates, and complication rates with the procedure you're considering. Therapies Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy: - Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck. The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent. Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing. - Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates. In this diet, called a 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 close supervision of their doctors - and remain seizure-free. Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when following the diet. Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised. Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control. Potential future treatments Researchers are studying many potential new treatments for epilepsy, including: - Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or the skull that sends electrical pulses to your brain and may reduce your seizures. - Responsive neurostimulation. Implantable, pacemaker-like devices that help prevent seizures are also under investigation. These responsive stimulation or closed loop devices analyze brain activity patterns to detect seizures before they happen and deliver an electrical charge or drug to stop the seizure. - Continuous stimulation of the seizure onset zone (subthreshold stimulation). Subthreshold stimulation - continuous stimulation to an area of your brain below a level that's physically noticeable - appears to improve seizure outcomes and quality of life for some people with seizures. This treatment approach may work in people who have seizures that start in an area of the brain that can't be removed because it would affect speech and motor functions (eloquent area). Or it might benefit people whose seizure characteristics mean their chances of successful treatment with responsive neurostimulation are low. - Minimally invasive surgery. New minimally invasive surgical techniques, such as MRI-guided laser ablation, show promise at reducing seizures with fewer risks than traditional open brain surgery for epilepsy. - Stereotactic laser ablation or radiosurgery. For some types of epilepsy, stereotactic laser ablation or stereotactic radiosurgery may provide effective treatment for people in which an open procedure may be too risky. In these procedures, doctors direct radiation at the specific area in the brain causing seizures, to destroy that tissue in an effort to better control the seizures. - External nerve stimulation device. Similar to vagus nerve stimulation, this device would stimulate specific nerves to reduce frequency of seizures. But unlike vagus nerve stimulation, this device would be worn externally so that no surgery to implant the device is needed. Lifestyle and home remedies Understanding your condition can help you take better control of it: - Take your medication correctly. Don't adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor. - Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night. - Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly. - Exercise. Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water, and rest if you get tired during exercise. In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes. 

Answer: To diagnose epilepsy, your doctor will review your symptoms and medical history. Your doctor may also order several tests. This may include a neurological exam, blood tests, an electroencephalogram, a computerized tomography scan, or magnetic resonance imaging. The electroencephalogram is the most common way to diagnose epilepsy. The more accurate your doctor knows about your seizure type and where the seizures begin in your brain, the better your chance for finding an effective treatment.