Epilepsy

Diagnosis

To diagnose epilepsy, your healthcare professional will review your symptoms and medical history and may perform several tests to identify the cause of seizures and determine the best treatment approach.

Neurological exam
A neurological exam evaluates behavior, movement, mental function, and reflexes. This helps determine whether epilepsy is present and what type it might be.

Blood tests
A blood sample can detect infections, genetic factors, or other medical conditions that may contribute to seizures.

Genetic testing
Genetic testing may be used to identify inherited forms of epilepsy and guide treatment, particularly in children but also sometimes in adults.

Brain-imaging tests
Imaging tests help detect structural or functional changes in the brain that may cause seizures. Common imaging and diagnostic methods include:

Electroencephalogram (EEG): The most common test for epilepsy. Electrodes placed on the scalp record electrical brain activity. Abnormal patterns can confirm epilepsy even when no seizure is occurring. Video monitoring during EEG may help identify seizure types and rule out other conditions.
High-density EEG: Electrodes are placed closer together for more precise detection of affected brain areas.
Computerized tomography (CT) scan: Uses X-rays to create cross-sectional brain images and detect tumors, bleeding, or cysts.
Magnetic resonance imaging (MRI): Provides detailed images of brain structures using magnets and radio waves to find abnormalities linked to seizures.
Functional MRI (fMRI): Measures brain blood flow to locate regions responsible for critical functions like speech and movement before surgery.
Positron emission tomography (PET): Uses a small dose of radioactive material to identify brain regions with low metabolism, which may indicate seizure activity.
Single-photon emission computerized tomography (SPECT): Detects blood flow changes during seizures to pinpoint their origin. An advanced version called SISCOM combines SPECT with MRI for enhanced precision.

Neuropsychological tests
These assess memory, speech, and thinking abilities to determine which brain areas are affected by seizures.

Advanced diagnostic techniques
Specialized methods can further pinpoint seizure origins:

Statistical parametric mapping (SPM): Compares blood flow patterns during seizures with those of non-seizure brains.
Electrical source imaging (ESI): Maps EEG data onto MRI images to locate seizure activity more precisely.
Magnetoencephalography (MEG): Measures magnetic fields produced by brain activity, providing a detailed view of seizure areas with minimal interference.

Accurately diagnosing seizure type and origin allows for a more personalized and effective treatment plan.

Treatment

Epilepsy treatment focuses on preventing seizures and improving quality of life. Most people achieve good seizure control with medication, while others may benefit from surgery, neurostimulation therapies, or dietary changes.

Medicines
Anti-seizure medicines, also known as anti-epileptic drugs, are the first-line treatment.

Many individuals can become seizure-free with one medicine, while others may need a combination.
Finding the right drug and dosage depends on factors such as age, seizure frequency, and other health conditions.
There are over 30 anti-seizure medicines available.
Side effects can include fatigue, dizziness, weight changes, skin rashes, or coordination problems. Rarely, serious effects like depression or organ inflammation may occur.

To ensure safe and effective treatment:

Take medicines exactly as prescribed.
Consult your healthcare provider before switching brands or adding other medications.
Do not stop taking medicine suddenly without medical advice.
Report any mood changes or suicidal thoughts immediately.

About half of newly diagnosed patients become seizure-free with their first medication. Others may need surgery or additional therapies.

Surgery
Surgery may be considered when seizures start in a small, well-defined brain area that can be safely removed. Options include:

Resective surgery: Removal of the seizure-causing brain tissue.
MRI-guided laser ablation: A minimally invasive technique using heat to destroy the target tissue.

Surgery can significantly reduce seizures and may allow for fewer medications afterward. However, it carries some risk of cognitive changes, so it requires careful evaluation.

Therapies
When medicines or surgery are not suitable, other treatments may help control seizures:

Vagus nerve stimulation (VNS): An implanted device sends electrical impulses through the vagus nerve to reduce seizure frequency.
Deep brain stimulation (DBS): Electrodes placed in the thalamus deliver regular electrical pulses to decrease seizure activity.
Responsive neurostimulation (RNS): An implant detects early seizure activity and delivers stimulation to stop it in real time.

Ketogenic diet
A high-fat, low-carbohydrate ketogenic diet may help children and some adults reduce seizures when medications are ineffective.

The body burns fats instead of carbohydrates for energy, altering brain chemistry to reduce seizures.
The diet should be supervised by healthcare professionals to prevent nutrient deficiencies.
Side effects may include constipation, dehydration, slowed growth, or kidney stones.
Less strict options like the modified Atkins diet or low-glycemic index diet can offer similar benefits.

Potential future treatments

Emerging therapies aim to improve seizure control and minimize side effects:

Subthreshold stimulation: Continuous mild brain stimulation below the threshold of perception to prevent seizures before they start.
Minimally invasive surgery: New methods like MRI-guided focused ultrasound reduce surgical risks.
Transcranial magnetic stimulation (TMS): Uses magnetic fields to target seizure-prone brain regions without surgery.
Transcranial direct current stimulation (tDCS): Delivers mild electrical currents through the scalp to gradually reduce seizure frequency.

Ongoing research continues to bring hope for better management and long-term relief for people living with epilepsy.