Epilepsy Diagnosis: How Do I Know If I Have Epilepsy?

Medical history, symptoms, and tests all help diagnose epilepsy

Epilepsy is a neurological condition in which a person has recurrent seizures. If you or your child has had a seizure, you may need to have a diagnostic evaluation to determine whether you need epilepsy treatment.

Getting a diagnosis of epilepsy can take weeks or longer. Throughout the diagnostic process, you may need to answer a lot of questions and have several medical tests. This helps determine the cause of your seizures and how to treat them.

This article covers details about the tests you may experience to diagnose epilepsy and what to expect. 

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How Is Epilepsy Diagnosed? 

Your symptoms and medical history are major aspects of an epilepsy diagnosis. You will likely need to see a neurologist for your epilepsy evaluation. A neurologist is a physician specializing in diagnosing and treating neurological disorders. 

Many people who have epilepsy do not experience seizure episodes during a medical visit, so a detailed description of the symptoms plays a crucial role in identifying the type of seizures that you could be having.

It’s also common for people to lose some memory or awareness of their own seizures, so observations from any witnesses can be especially helpful. 

Your neurologist and other healthcare providers will also review your medical history and family history. Some types of epilepsy are hereditary. Various health conditions can also increase the risk of epilepsy.

A few epilepsy risk factors are perinatal oxygen deprivation (low oxygen during birth or within the first few days of life), head trauma, a history of strokes, and a history of meningitis (infection or inflammation of the membrane surrounding the brain). 

Additionally, epilepsy can be caused by epilepsy syndromes. These conditions often cause seizures, along with metabolic problems or neurodevelopmental disorders. A comprehensive medical history can help your healthcare providers identify an epilepsy syndrome, such as Dravet syndrome, Lennox-Gastaut, neurofibromatosis, or adrenoleukodystrophy.

Neurological and Physical Exam

A physical examination for epilepsy involves a comprehensive physical examination, a neurological examination, and a neuropsychiatric evaluation. This examination can take around an hour, and you might need to see a neuropsychologist at a separate visit as well.

Some things you can expect as part of your examination include:

  • Evaluation of your facial appearance: Some medical issues that can cause epilepsy have a characteristic facial appearance, such as Down syndrome
  • A skin examination: Spots on the skin can be a sign of neurofibromatosis. This disorder causes skin discoloration and growths in the brain.
  • An evaluation of your speech: Neurodevelopmental disorders that cause epilepsy are often associated with changes in speech patterns or speech delays. 
  • Tests of your strength: A stroke or a brain tumor can cause weakness on one side of the body. 
  • Testing balance and coordination: Damage in the brain due to low oxygen often affects these abilities. 
  • Reflex testing: Many issues affecting neurological development can cause altered reflexes. 
  • Cognitive testing: Neurodevelopmental problems may impair thinking and problem-solving skills. 

These aspects of the physical examination can help your healthcare team identify causes of seizures and can also detect signs of some epilepsy syndromes. Your neurological exam will help point to other medical conditions that can cause seizures (such as a brain tumor).

An electrocardiogram (ECG or EKG) may also be performed to determine if the way your heart is working might be causing loss of consciousness or seizures.

Blood Tests

You may have blood and urine tests as part of your epilepsy evaluation. Routine screening tests can help diagnose other medical conditions that can cause a seizure. Some epilepsy syndromes can be diagnosed with blood tests—but these tests are not routine, and they would only be ordered if clinical signs point to these disorders. 

Blood and urine tests you might have during epilepsy evaluation include:

  • Urine toxicology screens can detect drugs that may cause a seizure.
  • Urine glucose levels can indicate severe glucose changes that could trigger a seizure. 
  • Urine volume may indicate dehydration or kidney failure, which can be associated with seizures. 
  • Blood chemistry profile can detect electrolyte (mineral) abnormalities (such as sodium, potassium, calcium, and magnesium) that can trigger a seizure.
  • Complete blood count (CBC) can detect signs of a severe infection that may trigger a seizure.
  • Blood culture may detect infections, such as bacterial or fungal infections, that can lead to brain infections.
  • Very long-chain fatty acids can be measured in the blood to help diagnose adrenoleukodystrophy.
  • Genetic tests can help diagnose Down syndrome, Dravet syndrome, adrenoleukodystrophy, and others.

Additionally, a lumbar puncture may be necessary. This test involves the placement of a needle into the lower back to obtain a sample of spinal fluid that can be tested for infections, inflammation, blood, or proteins.

The results of a lumbar puncture wouldn’t typically diagnose epilepsy, but these results could point to other causes of seizures that require treatment. 

Brain Imaging Tests

Certain imaging tests can often help in diagnosing neurological conditions and may identify changes in the brain that could cause epilepsy.

Tests used in epilepsy evaluation may include:

  • Electroencephalogram (EEG): An EEG is a noninvasive test that detects brain wave activity with the use of electrodes that are placed on the scalp. The result can show alterations in brain activity that could be indicative of an ongoing seizure or a predisposition to seizures.
  • High-density EEG: This type of EEG uses more electrodes than a standard EEG in order to distinguish electrical activity between nearby regions of the brain. It is not widely available but is used at some facilities.
  • Computed tomography (CT) scan: This imaging study normally takes about 10 to 15 minutes. It provides a detailed picture of the brain. A brain CT scan can help in diagnosing many different neurological conditions, such as a stroke or a brain tumor. Sometimes a brain CT scan may show developmental changes that could lead to seizures or epilepsy.
  • Magnetic resonance imaging (MRI) scan: This imaging study requires you to lie still for around 20 minutes. An MRI of the brain provides a more detailed picture than a CT scan and can often identify damage that could lead to seizures or epilepsy.
  • Functional MRI (fMRI): This type of MRI can evaluate activity in different areas of the brain, even when structural changes cannot be seen on a brain CT or a brain MRI. Changes in brain activity may predispose you to seizures. This may not be used in the initial diagnostic process but may be done before surgery.
  • Positron-emission tomography (PET) and Single photon-emission computed tomography (SPECT): These tests use injected materials to help create a picture of the structure and metabolism (function) of different areas of the brain.
  • Neuropsychological tests: Usually, neuropsychological tests are considered part of the physical examination. However, in some circumstances, neuropsychological testing could be done along with fMRI, PET scan, or SPECT to see changes in brain activity during testing.

Pinpointing Where Your Seizures Start

Most neuroimaging tests are done to identify a predisposition to seizures. These tests can help diagnose epilepsy and may help your healthcare providers decide which antiepileptic medications would be most beneficial for you.

Additionally, specialized tests can help pinpoint the location in the brain where a seizure is starting. Such tests are often used to define areas of the brain that could be targeted during epilepsy surgery. These tests include:

  • Statistical parametric mapping (SPM): This is a way of assessing the data obtained from diagnostic tests to determine whether certain areas of the brain have subtle changes.
  • Electrical source imaging (ESI): This emerging technique may potentially gain use in interpreting EEG studies.
  • Magnetoencephalography (MEG): This type of functional neuroimaging can be used with fMRI scanning to evaluate activity in different brain regions.

Types of Epilepsy

There are many epilepsy types, and they fall into the following categories:

  • Generalized epilepsy: Seizures begin on both sides of the brain and cause unresponsiveness and loss of consciousness. 
  • Focal epilepsy: Seizures begin in one area of the brain and can affect consciousness. 
  • Mixed epilepsy: A person has several seizure types. Some are focal, and some are generalized. 

Other Conditions to Rule Out

Seizures and seizure-like symptoms can be caused by conditions other than epilepsy. The treatment for epilepsy is different from treatment for other medical problems that could potentially cause similar symptoms. So, ruling out other conditions is an important aspect of getting the right treatment. 

Some of the other conditions your healthcare providers might consider include:

  • Transient ischemic attack (TIA): This condition, also called a ministroke, is a brief interruption in blood supply to a small region in the brain. It causes the same symptoms as a stroke (such as changes in speech and weakness of the face, arm, or leg on one side of the body), but it resolves before permanent brain damage occurs. A TIA indicates a stroke risk, and treatment involves stroke prevention. 
  • Syncope: A brief loss of consciousness can be the result of low blood pressure, a heart condition, or other underlying medical issues. The treatment of syncope is usually aimed at preventing further episodes by managing the underlying cause. 
  • Dystonia: This type of involuntary movement causes unusual changes in posture, such as twisting of an arm or leg. These movements may appear like seizures, but they don’t cause changes in consciousness, and people are often aware of their own dystonia. Causes of dystonia include antipsychotic medication, antiemetics (drugs used to prevent vomiting), and movement disorders.
  • Muscle spasms: These rapid muscle movements can appear like seizures, but they don’t cause changes in consciousness, and people are usually aware of their own muscle spasms. Neurological conditions that cause muscle spasms include multiple sclerosis, cerebral palsy, spinal cord damage, poststroke changes, and movement disorders.
  • Psychosis: Psychiatric conditions can cause delusions or hallucinations, sometimes with erratic behavior that may appear like a seizure.
  • Migraine: A migraine is usually characterized by a severe headache, but sometimes it can also cause neurological symptoms, such as tingling or vision changes. These experiences can sometimes cause a person to be concerned about whether they are having a seizure.

During your epilepsy evaluation, your healthcare provider may ask specific questions to determine whether you might be having any of these conditions.

Questions to Expect 

While getting your assessment for possible epilepsy, you will need to answer many questions about your seizures. These questions will help your healthcare providers determine whether you are having seizures or another neurological event.

Seizures can occur as a part of epilepsy or due to certain health conditions, even if you don’t have epilepsy. Additionally, if you are having seizures, these questions will help identify the type of seizures, the type of epilepsy, and the triggers.

Questions you may be asked include:

  • What happened during the event?
  • How did you feel before, during, and after the episode?
  • How long did the symptoms last? 
  • How many episodes have you had? 
  • Have you ever had any similar symptoms in the past? 
  • Has anyone in your family had similar symptoms? 
  • Were there any triggers or precipitating factors—such as a fever, illness, new medication, alcohol, drugs, or stress? 

The answers to these questions will guide your healthcare providers to a more tailored medical evaluation. 

Summary 

Epilepsy is diagnosed based on a medical history, physical examination, blood tests, and noninvasive diagnostic tests, such as brain imaging and electroencephalogram (EEG). An epilepsy diagnosis is aimed at identifying whether you have epilepsy and finding the cause of your seizures.

Your healthcare team will be able to consider which treatments are likely to be most effective based on the type of epilepsy you’re diagnosed with. 

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Heidi Moawad, MD

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.