Introduction
Epilepsy is a condition of recurrent seizures. As is the case for many neurologic diseases, no blood test or scan clinches the diagnosis. Epilepsy, in particular, can be particularly difficult to diagnose. Attacks may be atypical and infrequent. Even if there are witnesses, they may not know what to look for or become too upset by the event to remember crucial details.
Because epileptic seizures are brief and unpredictable, physicians rarely witness the actual event. Seizures can be confused with syncopal events, transient ischemic attacks, and certain psychiatric conditions. It's axiomatic in medicine that an accurate diagnosis leads to the most effective treatment. To diagnose epilepsy, physicians take a detailed history, perform a physical and neurologic examination, and obtain a brain MRI and a brain wave study called an electroencephalogram (EEG). Even after all these tests, it may still be impossible to make a definitive diagnosis.
I encourage family members and people who spend time with the patient to capture seizures on their cell phones and bring them to clinic. Videos taken by hospital staff prior to a patient being admitted for monitoring — for example, in the emergency department for monitoring — are also useful. A 10-second video is often worth more than a thousand words!
