Diagnosis and Treatment of Epilepsy

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If you have had a seizure, your doctor will try to determine what might have caused it, as well what types of treatment might be appropriate. Some questions the physician will try to answer include:

Was the seizure a result of a short-term illness (fever, infection) or an incident that can be remedied?
Was the seizure a result of a malfunction in your brain's electrical system?
Was the seizure caused by something within your brain's structure?
Was the seizure an isolated incident or do you have a pattern of seizures?

Answering these questions will involve you as a patient undergoing some physical tests conducted by your physician and other trained medical staff. These tests will most likely include a detailed and complete medical history, a thorough physical examination, blood tests, an electroencephalograph (EEG) test, and magnetic resonance imaging (MRI) and/or computed tomography (CT) scans.

Diagnosis

Medical History

Your medical history will be some of the most important information your doctor needs in reaching a diagnosis of epilepsy. In particular, he will want to know as much information as possible about your seizures from beginning to end — any unusual feelings you may have prior to, during, or after the seizure, how long the seizure lasts, what happened during the seizure, and how many seizures you have had. If you do not know what happens during your seizures, bring someone with you to your doctor’s appointments that has seen your seizures, or bring a written description from someone who has witnessed your seizures. Giving the doctor as much descriptive information as possible will help him to reach an accurate diagnosis.

Blood Tests

Blood tests may be ordered to determine the general physical well-being of your body. These tests can also be used to detect if you have an infection or been exposed to any poisons that may have caused your seizures.

Blood tests will also be used to monitor anti-seizure medication levels in your blood. This test is called a “blood level.” These levels are important because they will help tell you and the doctors that the anti-seizure medications you are taking are at an effective dosage level in your body. The goal of treatment with anti-seizure medications is to reach a dosage level that stops the seizures without creating any side effects. This level is called a “therapeutic level” and can be unique from person to person. A dose of medication that makes you feel sick because there is too much medicine in your bloodstream is called a “toxic” level, and each person’s toxic level of medication will be different, too.

Electroencephalograph (EEG) Tests

An EEG test may be ordered by your doctor to determine if there is any unusual electrical activity in your brain that may produce seizures. The test, which is safe and painless, consists of a technician pasting electrodes, or small metal discs with thin wires, onto your scalp. These electrodes then transmit your brain’s electrical impulses to a computer, which prints out the activity as a series of wavy or spiked lines. Any abnormal patterns will show up on the print-out, and these patterns will help your doctor in making a diagnosis of your seizure type, where in your brain your seizure activity is starting, and even what courses of treatment might work best for you.

The test, which can last anywhere between a half hour and an overnight stay, typically takes place in a hospital or outpatient epilepsy clinic. Often, the tests are videotaped, which may also assist a doctor in making a diagnosis if you happen to have a seizure while you are being monitored.

The technician may ask you to perform simple tasks while wearing the electrodes, including taking deep breaths through your mouth, blinking your eyes rapidly, or looking at a flashing light.

Children should be prepared in advance of an EEG test so as to make the experience as stress-free as possible. You can encourage your child to “practice” on a doll or stuffed animal.

Sometimes the history indicates that a person is having seizures, but the EEG results indicate normal brain electrical activity. If this is the case, the doctor may order a longer EEG test or one that uses special, ultra-sensitive electrodes that can pick up on fainter electrical impulses from your brain.

Brain Imaging

Several different types of tests that give your physician images of your brain may be ordered, including an MRI (Magnetic Resonance Imaging) or a CT (Computed Tomography) scan. Both types of tests help a doctor determine if there are any physical changes in your brains structure (including tumors, blood clots, malformations or scar tissue) that may be causing your seizures.

The tests are performed by a machine that looks something like a front-loading washing machine. You will lie on an examination table in front of the machine which will be slowly moved forward so that your head is inside the imaging chamber.

As with the EEG test, an MRI or CT scan is safe and painless, and children should be prepared in advance so that they know what to expect.

Treatment

After undergoing tests, doctors will look at the test results and make a diagnosis as to the cause of your seizures. If she makes a diagnosis of epilepsy, the most common form of treatment is anti-seizure medication. Other forms of treatment, including surgery, a special diet or vagus nerve stimulation (VNS) may be tried if medication is not successful in reducing or eliminating your seizures.

Anti-Seizure Medications

There are over twenty different anti-seizure medications available today. Most are effective for only certain types of seizures, so once the doctor has determined which type or types you have, he/she will then look at which medicine might be most appropriate for you as a form of treatment. Most types of medications are taken by mouth in the form of tablets, capsules, sprinkles or syrup. Click here for a list of common anti-seizure medications.

Different people react in different ways to anti-seizure medications. One drug may effectively control one person’s seizures, while that same drug may not work at all for another person. People’s bodies break medication down at different rates, meaning that their dosage levels will be different from each other’s. And, some people experience side effects from anti-seizure medications while others do not experience any negative side effects at all. All of this variation means that it might take a while for you and your doctor to find the right anti-seizure medication at the right dosage level for you.

Taking your medication at the prescribed time every day is an important part of your treatment. The medicine you take every day replaces what has been used by your body, keeping the medication level at the correct therapeutic level in your bloodstream. Skipping a dose, taking fewer pills than prescribed, or not filling your prescription on time can cause your medication level to be too low in your blood, which means that you may experience a seizure.

All medicines can cause side effects, including drugs to prevent seizures. Sometimes, the side effects go away after a while. Other side effects might happen because your anti-seizure drug is interacting with another drug that you are taking, or your anti-seizure drug may be building up in your body, reaching a toxic level. If you are experiencing any side effects, such as nausea, feeling very tired, staggering, slurring your words, or a rash, contact your physician right away.

Surgery

Brain surgery can be an effective treatment for epilepsy. Surgery is likely to be considered as a treatment option when:

You have tried anti-seizure medications without success
You have seizures that always start in one part of your brain
You have seizures in a part of the brain that can be safely removed and that will not affect your ability to speak, see or remember

Surgery for epilepsy will most likely be performed at special medical centers rather than local hospitals. In addition to operations that remove part of a patient’s brain, other types of surgeries can be performed to interrupt the spread of electrical disturbances in a person’s brain.

Patients are often awake during brain surgery since the brain does not feel any pain. Having the patient stay awake helps the surgeons make sure that important parts of the brain are not being damaged during the operation.

After brain surgery for epilepsy, you will most likely still have to take anti-seizure medications for a year or two. If no seizures occur during this time, your doctor may slowly wean you off of the medication. Some people are able to live seizure- and medication-free from this point on; however, many people still need to take their anti-seizure medication, and some have seizures that continue.

Diet

A special diet may be prescribed for children whose seizures have not responded to anti-seizure medications or other forms of treatment. This diet, called the Ketogenic Diet, is very high in fat, and must be carefully monitored by a dietician, physician, and the child’s family. It is not a do-it-yourself treatment. The diet is carefully tailored for the individual child, and the types and amounts of food the child eats must be strictly regulated.

The diet, which is very high in fat and very low in proteins and carbohydrates, produces a change in the child’s body chemistry called “ketosis.” Ketosis has an anti-seizure effect in about 2 out of every 3 children who try the diet.

The Ketogenic Diet is prescribed for children for a limited amount of time. After remaining on the diet for a while, doctors and the dietician will want to slowly taper off the diet and reintroduce regular food. If seizures return, the diet may be reinstituted. Studies are being conducted now to determine if the Ketogenic Diet may be an effective form of treatment for adults. Early results show that it may work, but the long-term effects of such a strict diet are not known at this point.

Vagus Nerve Stimulation (VNS)

Vagus Nerve Stimulation, or VNS, is another form of treatment that you may try if anti-seizure medications do not seem to be working. The therapy is designed to stop seizures before they begin by having a small battery, about the size of a silver dollar, implanted under the skin in a person’s left chest wall. This battery will be programmed by your doctor to send off bursts of electricity at a regular interval along your left vagus nerve, which is in your neck, via some electrodes that doctors will wrap around the nerve. This regular flow of electricity along this particular nerve has an anti-seizure effect in some patients who try it as a form of treatment.

If you have the VNS and you have an aura, or the sense that you are about to have a seizure, you can swipe a specially designed magnet over the implant, which will trigger it to send some electricity along the vagus nerve. Hopefully, this electricity will prevent the seizure from happening. Your family, friends and caregivers can also swipe the magnet over the implant while you are having a seizure in the hopes of reducing the length or severity of your seizure.

Some typical side effects of having the VNS implant include a tickle in your throat, coughing, and changes in your tone of voice while the implant is in the “On” phase of its cycle. These side effects often diminish with time, and while most people do not gain complete seizure control with the VNS, about two-thirds of the people who try it do have fewer seizures and see an improvement in their quality of life. Patients often need to continue taking their anti-seizure medications while also having the VNS implant.