Diagnosis of epilepsy in Children

Updated: June 16, 2022

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

Diagnosis of epilepsy in Children:

If your child has had more than one seizure without an identifiable reason, such as fever or injury, it is considered to be epilepsy. Diagnosis can be made by identifying a condition or disease based on signs and symptoms. You and your child may be asked to describe in detail what happened before, during and after the seizure. A video recording of the seizure can help the paediatrician understand what is happening.
Any child who experiences an unprovoked seizure needs immediate medical attention if the diagnosis of epilepsy is unknown. You should consult a pediatric neurologist if there is a reoccurance of the seizure. He will help manage seizures and epilepsy. The diagnostic process  for every child will vary. But the major steps in the process typically include:

Blood Test:

Blood test can identify potential causes and or other significant illnesses. 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. This test can be used to assess the risk of seizure recurrence and may help determine seizure type and epilepsy syndrome.

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 child's 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 child's 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 child's 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 child's 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 child's 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 child's thinking, memory and speech skills are assessed. The test results help doctors determine which areas of your child's 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.

Detailed account of the seizure:

The person who were present at the time of the child's seizure should communicate with the doctor.
You should work with the doctor to classify what type of seizures and epilepsy the child is having, and discuss treatment options once the diagnosis is made. Depending on the type of seizure, test results, the child's behavior during the seizure, and the expectations for a child's response to treatment, epilepsy can be classified.