Associated Symptoms

• Incontinence, usually of urine

• Tongue biting

• Traumatic injuries, usually associated with falling during a seizure Diagnosis

Description of events: The patient and any witnesses to the seizures should be carefully interviewed to obtain a full and complete description of typical seizures.

Neurologic examination: Usually, the neurologic physical examination is completely normal. Any neurologic deficits that are identified should be fully investigated because seizures do not usually cause permanent, detectable neurologic deficits.

Electroencephalogram (EEG): A routine EEG can be helpful if epileptiform discharges are seen. However, the EEG may be normal between seizures and most routine EEGs are not performed during a seizure. Maneuvers such as sleep deprivation, photic stimulation, hyperventilation, or prolonged monitoring can help expose EEG changes consistent with epilepsy.

Neuroimaging (preferably an MRI of the brain): Imaging of the brain is important to rule out obvious causes of seizures such as stroke or tumors. An MRI scan is also helpful in detecting mesial temporal sclerosis, a finding often associated with mesial temporal epilepsy and predictive of positive surgical outcomes.

Video EEG monitoring: A procedure consisting of continuous video monitoring of the patient with a simultaneous EEG. Usually a patient is monitored in the hospital for 4 to 5 days. This procedure is used to determine if the patient is truly having seizures, to determine the specific type of seizures the patient is having, and to localize the area of the brain that is the origin of the seizures.

In some patients, epilepsy worsens over time, with the seizures becoming more frequent as patients grow older. This does not occur in most patients with epilepsy. In those so affected, it is possible that the seizures themselves may cause some damage to the cortex; loss of neurons, especially inhibitory neurons, has been demonstrated in tissue from seizure foci. Other changes occur in brain areas affected by seizures: reorganization of connections between groups of neurons may strengthen excitatory connections and weaken inhibitory connections, making the occurrence of future seizures more likely. Additionally, epilepsy is associated with an increased mortality 13

rate. For these reasons, an argument can be made for controlling epileptic seizures with medications as early as possible. This may reduce the possibility of permanent changes in brain function, although this hypothesis is unproven.

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