Epilepsy Diagnostics

At Columbia St. Mary’s Epilepsy Center, an epilepsy evaluation begins with a clinical visit including a detailed discussion of your symptoms and medical history.  A neurologic examination and diagnostic testing may be conducted to understand seizure activity and to check for an abnormality or malformation that can cause seizures. 

The examination may include muscle strength, eyesight, hearing and sensation evaluations.  Blood tests, brainwave tests (such as an EEG or electroencephalography) and medical imaging (such as an MRI or magnetic resonance imaging) may also be conducted to provide critical information to your care team. 


        There are a number of blood tests that may be recommended as part of your epilepsy diagnosis.  A Complete Blood Count (CBC) may be ordered to measure the number of red and white blood cells, platelets, hemoglobin, hematocrit, and the size of the red blood cells.  A chemistry panel tests levels of sodium, potassium and blood sugar


        Results of these tests can both help determine what might be causing seizures as well as how to best treat the seizures.  The blood is collected through a needle inserted into your vein.  The blood is collected in one or two vials, and only takes a couple of minutes to complete. 


        The EEG is the only test that directly detects the brain’s electrical activity, and seizures are defined by abnormal electrical activity in the brain.  During the EEG, small metal discs called electrodes are attached to specific locations on the head.  These electrodes are able to monitor and record electrical activity in the brain.  Typically, the EEG records about 20-30 minutes of brain activity, although the entire procedure may take closer to 90 minutes.  Sometimes, prolonged monitoring is necessary to detect abnormal brain activity.


        Prolonged EEGs can be combined with video recording allowing your doctor to view the seizure and the EEG changes that come with it. Video-EEG (VEEG) monitoring provides the epilepsy doctor a longer view of what is happening in the brain. While hospitalized, patients have the EEG electrodes applied to the head and a continuous video image is recorded. Seizures are not often common enough to capture this information without a hospital stay. Also medication withdrawal is necessary to increase seizure frequency so we can get a clear picture of what are of the brain is responsible for the seizures. It helps us confirm seizure activity and create a treatment plan specific to each patient.


        An MRI uses a magnetic field and pulses of radio wave energy to make pictures of organs inside the body.  In order to make pictures of the brain, the head is placed inside a special scanner that contains a strong magnet during an MRI.  You will need to remove all metal objects from your body, and may need to take off all or most of your clothes and wear a gown during the test.  During the MRI, you usually lie on your back on a table that is part of the scanner, and your head chest and arms may be held with straps to help you remain still.  You will slide into the space that contains the magnet where the scans are taken.  An MRI usually takes 30 to 60 minutes but may take as long as 2 hours. 


        Additional tests are available to capture a picture of your brain. A single photon emission computerized tomography (SPECT) scan measures the blood flow throughout the brain and can show us abnormalities. This can help us by pointing to where a seizure may start.  A similar test is the positron emission tomography (PET).  PET scanning measures the use of sugar by the brain cells.  Both SPECT and PET reveal areas of abnormal blood flow and abnormal cell function and point to the source of seizures. 


These tests are not only useful in confirming an epilepsy diagnosis, but also in determining the type of seizure.  Accurate diagnosis leads to more effective, individualized treatment for each and every one of our patients.



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