Diagnosing Epilepsy

Technician preparing man for MRI scan.

Your primary healthcare provider may be the first healthcare provider to evaluate you for epilepsy. He or she may then refer you to a specialist for further evaluation. This specialist may be a neurologist (a healthcare provider who treats the brain), or an epileptologist, a neurologist who specializes in seizure disorders. Your evaluation will include a health history, physical and neurologic exams, and tests. An epilepsy diagnosis is typically made when someone has more than 1 seizure that occurs for no apparent reason (an unprovoked seizure).

Health history

This is the most important part of your evaluation. The healthcare provider will ask you to describe your seizures. The healthcare provider may also want to talk to family or friends who have seen your seizures. In addition, your healthcare provider will ask about your risk factors. These are things that make you more likely to have epilepsy, and include:

  • Being born before your due date (premature birth)

  • Oxygen deprivation during birth 

  • A family history of epilepsy

  • Past nervous system infection, like meningitis

  • A previous head or brain injury

  • Past stroke or brain tumor

  • A history of febrile seizures (childhood seizures caused by high fever)

  • Use of illegal drugs or alcohol

  • Certain genetic disorders

  • Alcohol abuse or withdrawal

  • Alzheimer disease

  • Gluten intolerance or celiac disease

  • Hydrocephalus or an abnormal buildup of fluid around the brain

  • Withdrawal of antiepileptic medicines, even when they are used for other conditions, such as gabapentin for pain 

Physical and neurologic exams

The physical exam checks your overall health. Your pulse, blood pressure, and temperature are taken. The neurologic exam checks certain functions of your brain. These include reflexes, balance, muscle strength, and coordination. Mental skills, like language and memory, and nerve function of the body are also checked.

Tests for epilepsy

After the exams are done, the healthcare provider may order some tests. Electroencephalogram (EEG) and MRI are the most common tests used to support a diagnosis of epilepsy.

Electroencephalogram (EEG)

An EEG records electrical activity in the brain. It can show abnormal signals that may mean seizure activity. In some cases, it can point to the area of the brain where seizures might start.

Imaging tests

Imaging tests may be used to create detailed pictures of the brain. These tests include MRI and CT scans.

Blood tests and other tests

You may have a sample of blood taken and tested. Other tests may also be done. These tests can help rule out certain health problems or provide more information.