Epilepsy: diagnosis and treatment
Diagnosing epilepsy
To diagnose epilepsy a doctor will first need a description of your symptoms, because it is unlikely that you will show any seizure symptoms when you are visiting your doctor.
Often a friend or parent who has been with you when you are having a seizure can help in describing what happens during the seizure, for example, how long it lasts, and whether or not you appear to lose consciousness.
Your doctor may also ask about the following:
- any other health problems or symptoms you have;
- illnesses or accidents you have had in the past, including head injuries and brain infections;
- medicines or recreational drugs you are taking;
- the age you were when the seizures started; and
- whether or not anyone else in your family has epilepsy.
Your doctor will do a full physical examination including a neurological examination, which aims to pick up any abnormal function of your nervous system.
Your doctor will usually want you to have some blood tests done and you’ll probably be referred to have an EEG (electroencephalogram) — a test that tracks the electrical activity of your brain. An EEG takes about one hour and is painless. It involves you having small electrodes placed (glued) on your head and attached via leads to a machine that traces the electrical activity of your brain onto paper or a computer screen. Your hair does not need to be cut, but to help the electrodes stick it should be thoroughly washed the night before.
You may also need to have a brain scan to show the structure and sometimes the function of your brain. There are several types of scans, including CT scans and MRI scans.
Often the results of these tests will be normal, despite the fact that you have had seizures. At least 50 per cent of people with epilepsy have ‘idiopathic’ epilepsy, meaning that no underlying cause can be found. However, these tests can be useful in detecting illnesses other than epilepsy that can also cause seizures.
It may be that your test results are normal between seizures but abnormal during seizures. To overcome this problem, an EEG is sometimes performed over a longer period of time while you stay in a hospital room that is fitted with video recording equipment. The aim is to record an EEG while a seizure is occurring, and also to record a video of the seizure itself. This can be very helpful to your doctor in deciding the type of seizures that you have and the best type of treatment.
You may be referred to a neurologist, who will interpret the results of your tests and discuss treatment options with you.
Treating epilepsy
With the right epilepsy medicines most people with epilepsy can have their seizures well controlled and lead normal lives.
Important elements of treatment include the following:
- continuing to take your epilepsy medicines at the doses and times that have been prescribed for you;
- sleeping well and regularly;
- striving for a balanced and healthy lifestyle;
- managing stress;
- eating well and regularly (seizures are more likely if you’re very hungry);
- finding out if your seizures have a particular trigger, such as flashing lights, video games or flickering sunlight (a small percentage of people with epilepsy have such triggers) and taking preventative steps to avoid seizures arising from these triggers;
- avoiding recreational drugs and excessive alcohol;
- having blood tests (to find out the concentration of the medicine in your blood, the function of your liver and kidneys, and your blood cell count) as advised by your doctor;
- being aware of possible interactions between epilepsy medicines and other medicines, including the contraceptive pill and some herbal remedies — ask your doctor before starting any new medicine; and
- talking to your doctor if you become pregnant or are considering becoming pregnant — your medicines may need to be adjusted and your epilepsy carefully monitored.
If you have epilepsy and you drive, it is important to talk to your doctor about the rules regarding driving and epilepsy. Your doctor may also advise you to avoid other activities that could be dangerous if you have a seizure, such as swimming alone and extreme sports, especially while your epilepsy is being brought under control.
If your seizures are not controlled as well as you’d like them to be, talk to your doctor. He or she may refer you to a neurologist for further assessment — your medicines may be altered, or other treatments such as surgery may be possible in some cases.
What makes epilepsy worse?
- Not taking your medicines properly or stopping them suddenly — this can trigger a severe seizure.
- Getting over-tired or over-stressed.
- Consuming a lot of caffeine.
- Missing meals.
- Being bored (remember to include regular exercise in your day).
- Drinking alcohol/taking illegal drugs.
- Having a fever or infection (treat these early).
- Hormonal and other changes during the menstrual cycle.
Last Reviewed: 26 October 2009
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