Diagnosis and Treatment of Epilepsy

Epilepsy is a neurological disorder in which brain activity becomes abnormal, causing recurrent seizures or periods of unusual behaviour, sensations, and sometimes loss of awareness.

Updated: June 16, 2020

Epilepsy is a neurological disorder in which brain activity becomes abnormal, causing recurrent seizures or periods of unusual behaviour, sensations, and sometimes loss of awareness.

Diagnosis of Epilepsy:

A seizure can be a symptom of a serious medical issue. Your medical history and symptoms will help decide which test need to be done to diagnose epilepsy. At the initial stage a neurological examination has to be done in order to test your motor abilities and mental functioning.

Blood Test:

Other conditions that cause seizures should be ruled out in order to confirm epilepsy. A complete blood count and chemistry of the blood should be analyzed to look for

  •     signs of infectious diseases
  •     liver and kidney function
  •     blood glucose levels

Electroencephalogram (EEG):

This is the most common test used in diagnosing epilepsy. It is a noninvasive and painless test. You may be asked to perform a specific task when electrodes are attached to your scalp with a paste. The electrodes will record the electrical activity of your brain. Changes in normal brain wave patterns are common in epilepsy whether you are having a seizure or not. In some cases, the test is performed during sleep.

Imaging Tests:

Imaging tests such as CT scan, MRI, functional MRI, positron emission tomography (PET) and single-photon emission computerized tomography can reveal tumors and other abnormalities that can cause seizures.
A CT scan uses X-rays to obtain cross-sectional images of your brain. It can reveal abnormalities such as tumors, bleeding and cysts in your brain that might be causing your seizures.
An MRI uses powerful magnets and radio waves to create a detailed view of your brain which will help detect lesions or abnormalities in your brain that could be causing your seizures.
A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. It should be done before surgery to identify the exact locations of critical functions, such as speech and movement to avoid injuring those places during operation.
PET scans use a small amount of low-dose radioactive material that is injected into a vein to help visualize active areas of the brain and detect abnormalities.
If you have had an MRI and EEG that did not pinpoint the location in your brain where the seizures are originating, a single-photon emission computerized tomography can be done. A SPECT test uses a small amount of low-dose radioactive material that is injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.
Subtraction ictal SPECT coregistered to MRI (SISCOM) is a type of SPECT which may provide even more-detailed results.

Neuropsychological tests:

In this test your thinking, memory and speech skills are assessed. The test results help doctors determine which areas of your brain are affected. A combination of analysis techniques  along with the test results are done to help pinpoint where in the brain seizures start. These include:

Statistical parametric mapping (SPM):

SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains. This will provide an idea of where seizures begin.

Curry analysis:

Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to confirm where seizures are occurring.

Magnetoencephalography (MEG):

MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset. If you have seizures for no apparent or reversible reason, epilepsy is usually diagnosed. Accurate diagnosis of your seizure type and the exact location where seizures begin gives you the best chance for finding an effective treatment.

Treatment of Epilepsy:

Treatment plan will be based on severity of symptoms, health condition and how well you respond to therapy. Some treatment options include:

Anti-epileptic drugs:

These medications can reduce the number of seizures and in some cases eliminate seizures completely. The medication must be taken exactly as prescribed to be effective.

Vagus nerve stimulator:

This device is surgically placed under the skin on the chest and electrically stimulates the nerve that runs through your neck which can help prevent seizures.

Ketogenic diet:

This high fat, low carbohydrate diet can help treat epilepsy for people who do not respond to medication.

Brain surgery:

The area of the brain that causes seizure activity can be removed or altered.

Medications for epilepsy:

Antiseizure medication can help reduce the frequency and severity of seizures. These medications neither cure epilepsy nor can stop a seizure that is already in progress.
Antiseizure medications pass through the digestive tract and  is absorbed by the stomach. Then it travels the bloodstream to the brain and leave the body through urine.  It affects neurotransmitters in a way that reduces the electrical activity that leads to seizures.
Depending on the type of seizures you have, your doctor can prescribe a single drug or a combination of drugs. Common epilepsy medications include:

  •     valproic acid (Depakote)
  •     levetiracetam (Keppra)
  •     ethosuximide (Zarontin)
  •     topiramate (Topamax)
  •     lamotrigine (Lamictal)
  •     carbamazepine (Tegretol)

Usually these medications are available in tablet, liquid, or injectable forms and are taken once or twice a day. You should start with the lowest possible dose, which can be adjusted until it starts to work and must be taken consistently as prescribed.
Fatigue, dizziness, weight gain, loss of bone density, skin rash, poor coordination, speech problems and memory problems are some of the potential side effects of these medications.
Depression, suicidal thoughts and behaviors, severe rash and inflammation of the liver or other organs are some of the serious side effects which are rare. Most people improve with antiseizure medication.

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