If you have had symptoms of a seizure, your doctor will begin by looking for an underlying medical trigger, such as low blood sugar or eclampsia. If your doctor can confirm a definite medical reason for your seizure, your treatment will be geared toward correcting the underlying illness.
If your seizure appears to be unprovoked (not triggered by any underlying medical problem), your doctor will review your medical history, family history and any eyewitness reports of your seizure symptoms. Next, the doctor will perform a thorough physical and neurological examination and order routine blood tests. In most cases, the results of your examinations and blood tests will be normal.
Your doctor also may order an electroencephalogram (EEG), a painless test that detects the electrical activity in your brain and translates it into a series of printed patterns. In 40% to 50% of people with epilepsy, the first EEG will show a specific combination of patterns that confirms the diagnosis. If the first EEG is normal, repeat EEG tests usually will detect the abnormal brain-wave pattern.
Sometimes, even when a series of EEG tests fails to show evidence of seizure activity, the diagnosis can be based on evidence from the reports of people who have seen your seizure episodes.
In some cases, the doctor may also order a magnetic resonance imaging (MRI) or computed tomography (CT) scan of your brain to look for evidence of a local problem, such as a brain tumor or scarring from a previous brain injury. These scans are especially important if:
You are an adult with your first generalized seizure.
You have an unusual pattern of symptoms.
Your neurological exam is abnormal.
You have a history of brain damage (birth trauma, head injury, train tumor, encephalitis, meningitis).
About half of all people who have one unprovoked seizure never have another.
Most people who have epilepsy can avoid seizures if they get enough sleep and take prescribed medications as directed. Most people with epilepsy need to take medication indefinitely. Never stop medication without specific instructions from your physician.
If you have had only a couple of seizures and have a normal EEG, your doctor might reevaluate the need for medication if you have no seizures after two to five years.