Diagnosis
Already after an epileptic seizure has occurred, a careful examination must be performed. This examination will determine whether there is an increased probability that further seizures could follow. Genetic causes, as well as structural and metabolic reasons are examined in detail and, if possible, diagnosed or excluded.The diagnostic procedure is structured as follows: The type of seizure must be determined, therefore a detailed conversation is important.
When, where and how often did the epileptic seizure occur? Was there a suspected trigger? Were you still conscious?
Did the whole body twitch, or only a part of it? These and other questions will be asked. The age of manifestation is also part of the diagnosis, as there are different causes of epilepsy in different age groups.
For example, if a seizure occurs in adults, one is more likely to assume a symptomatic seizure event, such as brain tumor, inflammation, etc. In adolescents, genetic seizures are more likely to come to the fore. The EEG findings as well as the imaging findings by means of computer tomography of the head and magnetic resonance imaging of the head are further important components of diagnostics.
The EEG can often filter out important causes for the development of cramping disorders. However, it should not be forgotten that in many cases the EEG can be completely normal during a seizure. CT and MRT of the brain are part of the initial examination to exclude possible symptomatic causes.
In addition, inflammatory processes in the central nervous system can cause epilepsy, which is why a cerebrospinal fluid puncture should be performed if clinical suspicion exists. In the case of certain suspicions, an organ-specific (“internal”) diagnosis is performed. In particular, provocation factors such as alcohol, drugs, fever and other factors such as hypoglycaemia or hyperglycaemia are examined.
What do you see in the MRI of epilepsy patients?
The MRI belongs to the standard diagnostics, which was almost always performed after the occurrence of the first epileptic seizure. This imaging procedure can, for example, detect brain lesions that can lead to epilepsy. Furthermore, in some cases, changes caused by the previous seizure can also be detected.
The latter are usually characterized by an increased contrast image or circulatory problems. Particularly in the case of focal epilepsy, i.e. epilepsy that originates from a specific epileptic focus, changes in the brain structure can be detected in the MRI. Furthermore, the calcification of certain brain structures, such as the hippocampus, can be detected in an MRI, which can also be an indication of certain forms of epilepsy.
