How is epilepsy diagnosed?

Diagnosing epilepsy is not always straightforward, but with the right care and investigation, your doctor will find you the best course of action. 

This article will give you an overview of how epilepsy is diagnosed, types and causes of seizures, and diagnostic testing options.

Is it epilepsy?

Epilepsy is an ongoing seizure disorder, so the first step in getting a diagnosis is to determine if the event experienced was a seizure or something else. Seizures are the result of abnormal electrical discharges in the brain, so to assess if an event was in fact a seizure, doctors will closely consider the symptoms along with an electroencephalogram (EEG)

If the event is indeed found to be a seizure, it may not necessarily mean that the person has epilepsy. Seizures can be caused by circumstances other than epilepsy. For example, fever or infection — among many other conditions — can bring on seizures. Once these conditions are resolved, seizures might never occur again.

Common seizure symptoms

Seizures can come in all shapes and sizes. If you think you have experienced a seizure, seek medical advice immediately or call “000” if it is a medical emergency. 

Symptoms of seizures include:

  • Confusion — Some people become disorientated to the place, time, and the people with them
  • Staring into space — Pausing in attention or activity. People often don’t notice having these as they can be very brief and subtle
  • Odd feelings/sensations — Feelings of déjà vu, sudden mood changes, tingling sensations, or even unusual perceptions or hallucinations in the form of sights, sounds, and smells. These are known as auras
  • Freezing — Some people freeze entirely during the seizure and are unable to communicate or respond
  • Automatisms — Repetitive actions that normally wouldn’t happen such as repetitive swallowing, chewing or walking in circles
  • Suddenly falling — Caused by a loss of muscle tone
  • Muscles stiffening — Sudden extreme tension in the limbs which can cause falling. This leaves people feeling very tired
  • Repetitive jerking movements — Very brief twitches or rhythmic jerking of a muscle or muscle group

Doctor talks with patients

Start by seeing your doctor

If you’re making an appointment to discuss your symptoms for the first time, it’s likely you’ll start with seeing your General Practitioner (GP). In some cases, you may get referred to a neurologist straight away. Read this article for more information about who can diagnose and treat seizures

Come prepared with information and questions for your doctor when you go to your appointment. Giving your doctor a clear recount of what happened during an event goes a long way in helping them on the way to a diagnosis. 

Details you should note down after an event to share with your doctor include:

  • Where and when the event occurred
  • Any strange feelings or sensations leading up to the event 
  • What your body did during the event — if you can, be specific about what you remember or what others told you
  • How aware you were during the event
  • How you felt after the event
  • Roughly how long it lasted

You can easily keep track of your events with detailed notes using the Seer App

Here are some additional points your doctor will want to know about:

  • Family history of epilepsy
  • Alcohol consumption
  • Recreational drugs use
  • Any major head injuries in the past
  • More than usual stress

 

[PDF] Download our “Preparing for your appointment” worksheet before you see your doctor for the first time after an event.

 

In many cases, the person who has an event can lose awareness and even consciousness and may have to ask a witness for the specifics. It’s a good idea to bring someone who witnessed the event along to your appointment, as they may be able to offer more insight into what happened. If no one was there with you, it’s still a good idea to have an extra set of ears at your appointment since there is usually a lot of information to cover. 

What happens in the brain during a seizure?

The cells in our brain (neurons) communicate through small electrical impulses which coordinate functions like thoughts, emotions, behaviour, speech, memory, movement and sensory input. When neurons are functioning normally the impulses create small steady changes in electrical activity around the brain. 

Interconnected neurons with electrical pulses (3D illustration)

Seizures occur when neurons function abnormally creating large impulses which cause sudden bursts of electrical activity. The normal signals are briefly stopped, or altered, resulting in some of the symptoms mentioned before.

Epileptic seizures and non-epileptic seizures

Epileptic seizures are caused by abnormal activity between neurons in the brain. Non-epileptic seizures (NES) are seizures that are caused by something other than abnormal neural activity. 

Physical conditions such as diabetes, infection, and fever can affect the central nervous systems and cause NES.

Extreme mental stress and psychological problems can also provoke events that look very similar to seizures but are not caused by abnormal electrical activity. Psychogenic non-epileptic seizures (PNES) or dissociative events are the preferred name for these, although you may hear some other out-dated terms from time to time.

Outdated terms:

  • Pseudoseizures 
  • Functional events

People who experience NES and PNES require specialised treatment. The person may experience many of the same symptoms as someone with epilepsy, making it possible to misdiagnose the condition. 

EEG trace of human brain, brain wave patterns on electroencephalogram, problems in the electrical activity of the brain

An EEG trace

Types of tests

After you see a doctor about an event, it’s likely that you’ll be sent to have an EEG. An EEG records the electrical activity of your brain as waves — this is called an EEG trace. Abnormalities in the brainwaves can be seen on the trace. 

Here are some of the different types of EEG tests:

  • Routine EEG — A 20-30 minute test to see if there are any consistent or regular abnormalities
  • Sleep-deprived EEG — A test where the person does not sleep for an extended period. Lack of sleep can be a seizure trigger for some people. Some abnormalities may only be visible during sleep
  • Prolonged EEG — These take a minimum of 3 hours and are used to capture events that occur reliably but not frequently enough for a routine EEG to get
  • 24-hour EEG — Extended monitoring in hospital to increase the likelihood of capturing activity needed to make a diagnosis
  • Ambulatory EEG — The test is set up to be portable allowing the patient to move around freely and continue normal activities for a day whilst being monitored
  • Long-term EEG — These can be from 3-10 days of monitoring at home or in hospital with the aim of capturing events and assessing their frequency

A variety of other medical tests may also be ordered to further explore the cause of seizures. These include:

  • Computed tomography (CT) and magnetic resonance imaging (MRI) — A scan of the brain to investigate structural abnormalities (possibly causing seizures), such as a lesion or tissue damage
  • A lumbar puncture — A ‘spinal tap’ on the lower back to remove a sample of fluid. This is done if it’s suspected that an infection is causing seizures
  • Genetic sample testing — A blood test to determine if congenital abnormalities are causing seizures

Testing with Seer Medical

Video-EEG-ECG is considered the gold standard of testing for diagnosing and assessing seizures and epilepsy. Previously, this kind of testing has only been available in hospital, with long waitlists for routine EEGs that offer less insight, or longer EEGs with uncomfortable stays. Seer Medical offers a more accessible, comprehensive, and convenient alternative for video-EEG-ECG monitoring.

Monitoring from 3-10 days offers the best chance of capturing an event. Once you’ve been connected at one of our clinics, you will go home with a wearable monitoring device and portable camera. At home, you can relax, move freely, and go about your day as usual. 

Logging the events via the Seer App allows our clinical scientists to align the events you experience with the EEG trace picked up from your monitoring device so we can see what’s happening. 

Take a look at this article for more insight into the benefits of video monitoring with EEG. If you think our testing might be right for you or would like more information ask your doctor or contact us.


FAQ

Q: Does epilepsy show up on MRI?


A: No. Structural or functional abnormalities in the brain, that can be a cause of epilepsy, can be seen on MRI and fMRI.

Q: My results were not abnormal so why am I still experiencing events?

A: There are many reasons that you may still be experiencing events. It may be that longer monitoring is needed, or the nature of the events are not epileptic and different testing is required, or your medication needs to be adjusted. The best course of action is to keep a detailed record and descriptions of your events and speak to your doctor. 

Q: How is epilepsy treated?

A: Treatment depends on the type of epilepsy, but the most common route is medication. In some cases surgery, ketogenic diet, and/or nerve stimulation may be good options.

Q: If I am diagnosed with epilepsy will I have it forever?

A: Around 60% of people diagnosed with epilepsy achieve control over their seizures through medication. Some people have epilepsy which is age-dependent and resolves with development. The International League Against Epilepsy deems epilepsy as resolved if someone has been seizure-free for 10 years and off anti-seizure medication for at least 5 years.

 


Written by Rebecca

Rebecca joined Seer Medical in 2020 as a neurophysiology scientist. Prior to this, she was working at the Queensland Children Hospital performing various neurodiagnostic tests. Rebecca graduated from the University of the Sunshine Coast with a Bachelors Degree of Biomedical Sciences, where she majored in clinical measurements. Rebecca takes pride in providing the best care possible with her patients when setting them up for monitoring and makes it her goal to get the best quality data for them and their doctor.