Department of Neurology

How is epilepsy diagnosed?

Q: A relative of mine was recently told that she "probably" has epilepsy. She is a young adult and has been having fainting spells over the past few years. The spells have been more frequent in the past several months. She has also been told over the years that she may have diabetes, possible liver disease, migraines and a variety of other conditions - none of which any physician seems to follow through with treatment.

This relative has a tendency to be melodramatic and I fear that she would rather tell people that she has the worse condition among a list that a physician may have mentioned. She has poor eating habits, is extremely thin, although I do not suspect an eating disorder. Thinness runs in her family, but not epilepsy or any of the other conditions she claims she may be suffering from. She is in poor dental repair and does not seem to have a sense of how to take care of herself from a nutri tional standpoint. Yet she is always suffering from one illness or another. We try to take her seriously and do believe that something is wrong, but it may be something she can control by taking better care of herself. Having any of these conditions is certainly not something that should be so loosely claimed.

I have "surfed" for question and answer sites that address how someone conclusively gets diagnosed as having epilepsy. I have not seen this addressed. Can you help me out?

Thanks.


A: The diagnosis of epilepsy is largely a clinical one, meaning that the diagnosis is made from the history obtained from the patient, observers, and from supportive laboratory data, such as EEG and brain imaging studies (CAT and MRI scans). However, there are no blood tests for epilepsy, and a person can have negative EEG and brain scans and still have epilepsy. Nonethess, for most patients, accurate diagnosis can generally be made on the basis of a history and routine studies (brain imaging and EEG). For a subgroup of patients, it may be necessary to actually record the events. This is performed by simultaneously recording the events with both video and EEG recordings.

It would be best to start with a thorough evaluation by a physician with special training in epilepsy. There is a list of epilepsy centers on the Epilepsy Foundation of America (www.efa.org) Web Pages if you need to locate one near you.

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