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How is Epilepsy Diagnosed?

Find out how epilepsy is diagnosed from Steve Wolf, MD and Patty McGoldrick, NP in this Howcast video.


Speaker 1: So we diagnosis Epilepsy by a variety of different methods. The first thing that we start with is a description of the seizure, or the event that the patient reports. And it also depends on whether they present for the first time with a seizure in the emergency room, or they go to the pediatrician's office and then are sent to the neurologist's office. But the workup is pretty much the same.

Speaker 2: It's really important to get all the information. So the family members that come in, and whoever witnessed it, get a really good description of what they saw. And then ask the patient what did they feel before the episode happened. What do they remember? And then get a description from everybody of what happened during that time of the seizure.

Speaker 1: So we like to know what happened first. Did the head turn? Did the eyes turn? Are they confused? Did one arm go up and twitch first? Did one leg go up? Or was it just a staring spell, with maybe a little bit of eye deviation?

Speaker 2: Making a diagnose of Epilepsy is like playing detective.

Speaker 1: Right. So you really have to find if, those are all clues that lead us to decide whether it's a focal Epilepsy, or whether it's generalized. We also ask things like how long did it last. And nobody can ever answer that question. Because it's so upsetting to watch somebody have a big generalized tonic quantic seizure, that nobody really knows exactly how long it lasts.

Speaker 2: What's confusing though, is that sometimes the beginning of the seizure, whether the patient's confused, lethargic, they might not realize that that's part of the seizure. And then also frequently when the seizure ends, where they're tired, and sleepy, and snoring, they might think the seizure's still continuing. And that's not necessarily the end of the seizure.

Speaker 1: And a lot of times medication will be given at that point, despite it not really being a seizure anymore. So what we do then, the tests that are done first, and most important test in diagnosing epilepsy, is the EEG. Which entails putting little electrodes on their head, and looking at the electricity in their brain.

Speaker 2: Doing a picture of the brain, an MRI, is also very important. So those are the two basic tests that we do in making the diagnosis. As well as listening to the history.

Speaker 1: So again, the most important parts are the history, the description of the event, an EEG. And sometimes we do a short EEG. We often follow that with a longer one for 24 hours. Sometimes we'll do a video EEG, where they stay overnight in the hospital with a video camera on them. And then neuro-imaging, which is the MRI, or the cat scan. And MRI being much more the gold standard for looking at the brain.

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