To make a diagnosis of epilepsy, it is necessary to establish a tendency to recurrent spontaneous epileptic seizures. Many people have a single isolated epileptic seizure at some point in their lives, but if a person has more than one epileptic seizure, then a diagnosis of epilepsy may well be considered.
	Epileptic seizures are due to an intermittent and temporary disturbance in the brain which produces some or all of the following symptoms — disturbance of consciousness or awareness, alterations of bodily movement, sensation or posture.
	More often than not the person concerned will have no recollection of what has actually happened. For this reason it is very common for someone else, (such as a parent, or spouse) to report the seizure to the doctor. Seeing a person having an epileptic seizure for the first time is a frightening experience. Nevertheless, it is very important to remember and relate accurately all the events surrounding the seizure and the details of the seizure itself. The doctor is heavily dependent on an accurate eye-witness account of the seizure, which may be the only information upon which the diagnosis rests.
	HE FELL TO THE GROUND AND BEGAN TO SHAKE AND TWITCH UNCONTROLLABLY- SEEMED TO HAVE TROUBLE BREATHING AND BECAME PALE AND CLAMMY.
	AFTER ABOUT 2 MINUTES THE SHAKING CEASED AND HE CAME ROUND, BUT WAS A BIT CONFUSED.
	BEFORE THE SEIZURE HE WAS ACTING QUITE NORMALLY - BUT SUDDENLY HE CRIED OUT AND THE SEIZURE BEGAN.
	The doctor will also need answers to certain questions which he may ask of the person who experienced the attack and the person who was with them at that time. Some of the questions, only a parent may be able to answer.
	Was there any warning immediately before the attack happened? Was the person who experienced the attack tired, hungry, thirsty, hot or very emotional before the attack occurred? Did they feel unwell before the events i.e. sick, dizzy, faint or breathless. Were there any chest pain or palpitations? What was the person doing at the time of the attack? What actually happened before, during and after the attack and how long did the attack last? What is the first memory after the attack and was there any muscle weakness afterwards? Were there any birth complications when they were born? Have they ever had any head injuries? Did they ever have convulsions with a high temperature as a child? To help confirm the diagnosis, the doctor may arrange for the person to have a number of tests. These may also help to determine whether there is any identifiable cause of the epilepsy. The tests alone do not make a diagnosis of epilepsy; this remains a clinical decision based on what has happened to the person.
Diagnostic Tests
	Blood Tests
	These check the general health of the person and help to exclude a metabolic cause for the attacks / sugar test.
	EEG
	(Electroencephalogram)
	This test records the brain’s activity by picking up the tiny electrical signals given off by communicating nerve cells. Electrodes are placed on the scalp and the signals picked up are then amplified and recorded onto paper. It is a painless procedure which usually lasts about 20-30 minutes. At some point during the test, the person may be asked to breathe deeply, open and close his/her eyes and he/she may also be asked to look at a flashing light for a few seconds to see if the record changes in response to certain frequencies. If an individual has photosensitive epilepsy i.e. their seizures are triggered by flashing or flickering lights, on the EEG will reveal this. (The CIEN fact sheet “Photosensitive Epilepsy” gives more information about this). It should be remembered that the EEG can only give information about the electrical activity of the brain during the period of recording. Only if patterns characteristic of epilepsy are seen during the routine recording, is the EEG of value in the diagnosis of epilepsy. A negative EEG does not exclude a diagnosis of epilepsy.
NEUROPHYSIOLOGY
	EEG Ambulatory Monitoring
	Ambulatory Monitoring allows the activity of the neurons to be recorded for several hours, days or sometimes even weeks. Electrodes are again attached to the scalp and are hidden under the hair. The wires are then connected to a small cassette tape recorder which is worn on a belt around the waist. The person can then continue with his/her day to day activities. There is a button on the recorder which can be pressed either by the persons themselves if they know they are going to have a seizure or by an observer if the seizure occurs.
	Video Telemetry
	This test involves both EEG and video recordings being made simultaneously and is available at some hospitals and specialist centres. The purpose of the test is to try and record a seizure on video as well as the EEG trace on paper. The electrodes are attached to the scalp as before and the person is usually able to move freely around the room within view of the video camera.
	Brain Scans
	If the doctor is satisfied that the events were epileptic seizures the person may be referred to have a brain scan.These are carried out to see if there is any structural cause for the epilepsy. Computerised Tomography (CT or CAT) These scans use computerised X-ray techniques and they may reveal any very obvious structural abnormality or damage which may be present.
	Magnetic Resonance Imaging (MRI)
	MRI uses harmless magnetic fields and radio waves to form an image of the structure of the brain. MRI can reveal far smaller structural abnormalities than CT and so is preferred by many doctors. Fact sheet on MRI available at CIEN.
	Drug Treatment
	Once a diagnosis of epilepsy has been made the doctor will usually suggest starting treatment in an effort to control the seizures. The most commonly Recommended form of treatment is with anti-epileptic medication and more information about this is available in “Drug Treatment of Epilepsy”. However, some people have very infrequent seizures, sometimes separated by a number of years and in these cases they may not want to start treatment, especially if they do not wish to drive. The doctor and the person themselves should decide together whether or not to start treatment. The diagnosis of epilepsy may have many non-medical implications affecting education, work, leisure, life insurance etc. All these should be considered when discussing possible treatment. If the person themselves are not involved with the decision-making, treatment may well not be taken reliably, leading to further problems. It is important to remember that up to 80% of people with epilepsy achieve total control of their seizures with the right anti-epileptic drug.
	Surgery
	Neuro-surgical treatment may be considered if the drug treatment has been shown to be ineffective and if one specific part of the brain can be identified as being the area from which the seizures arise. There is more information on this form of treatment in the CIEN fact sheet “Facts about Epilepsy Surgery”.
	Reactions to a Diagnosis
	People will react to a diagnosis of epilepsy in different ways. Many people are very shocked to hear that they have epilepsy. Others may be relieved to finally know what has been causing the “episodes” and to know that treatment can be started. Anger is another very commonly felt emotion as epilepsy can have such a major impact on someone’s lifestyle. Most people will probably experience a range of different emotions and it is only natural that they should do so.
	People often feel that they want to talk to others about their diagnosis and the CIEN co-ordinates a Community Network of local groups offering support and information to people with epilepsy, their families and carers.
	Some people will feel the need to have formal counseling whereby the counselor helps the person to recognise, verbalise and work through any negative emotions and concepts they may have so that they can reach a stage of acceptance. The Psychologist and Counselor at CIEN may be contacted.