Obligatory medical device diagnostics.
- Encephalogram (EEG; recording of electrical activity of the brain) – provides information about electrical brain activity; for first-time epileptic seizure.
- [generalized epilepsy: typical generalized spike-wave activity;
- [focal epilepsy: interictal focal discharges.
- Combined generalized and focal epilepsy: in interictal EEG typically generalized spike waves and focal discharges on]
- Magnetic resonance imaging of the skull (cranial MRI, cranial MRI, or cMRI) [epileptogenic lesion?]
- Computed tomography of the skull (cranial CT, cranial CT or cCT) – high radiation exposure; for first-ever epileptic seizure to determine the exact cause; cMRI is superior to cCT in most cases.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Long-term ambulatory EEG/sleep deprivation EEG – for suspected disorder based in sleep deprivation.
- Positron emission tomography (PET; nuclear medicine procedure that allows the creation of cross-sectional images of living organisms by visualizing the distribution patterns of weak radioactive substances) – indicated in therapy-resistant epilepsy.
- Single photon emission tomography (SPECT; functional imaging method of nuclear medicine, with which based on the principle of scintigraphy sectional images of living organisms can be created) – indicated in therapy-resistant epilepsy.
Further notes
- In children with a first seizure without a known trigger, a cranial CT showed about a fourfold increased rate for abnormalities if the children had a history of tumor disease, coagulopathy (blood clotting disorder), apoplexy (stroke), heart defect, or sickle cell disease (sickle cell anemia). In focally dominated seizures, they found about a two- to two-and-a-half-fold increased rate of abnormalities.
- Ictal magnetoencephalography (MEG), i.e . epilepsy during MEG, leads to better seizure localization, i.e. more precise detection of the epilepsy focus.