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Epilepsy Testing, Diagnosis and Stages

If you think you’ve had a seizure, see your doctor as soon as possible. An early epilepsy diagnosis is important for effective treatment and symptom management. Banner Health’s experienced neurosciences team is here to help you every step of the way. We ensure you receive comprehensive and accurate testing for epilepsy and seizure disorders to get you the answers you need. Banner Health offer consultation with epilepsy specialists (epileptologists) who have specialty training after obtaining neurology board certification.

How Is Epilepsy Diagnosed?

Epilepsy is usually diagnosed if you have two or more seizures. Your doctor may recommend various epilepsy tests to rule out other seizure causes and confirm epilepsy diagnosis, including:

  • Physical exam and evaluation: Review your current health, medical history, birth history and symptoms.
  • Neurological examination: Evaluate your motor skills and cognitive ability.
  • Blood count: Identify signs of infectious diseases, toxins, liver and kidney function and blood glucose levels.
  • Electroencephalogram (EEG): A noninvasive test that uses electrodes on your scalp to record electrical activity in your brain (brain rhythm). It’s common to see different brain wave patterns in people with epilepsy. 
  • Imaging tests: A CT scan, MRI or PET can show tumors or other abnormalities in the brain that may cause seizures. In patients with severe epilepsy dedicated special high resolution MRI scan may be necessary.
  • Epilepsy Monitoring Unit tests (EMU): For those patients with refractory epilepsy, some patients are referred to inpatient video-EEG recording in the epilepsy monitoring unit, in order to capture the stereotypical seizures and to localize where seizure are originating from. This study would be necessary for those people who are considering elective epilepsy surgery. In addition, EMU can be sued to better characterize seizures when the diagnosis is not clear even though surgery is not considered.   

What Are the Stages of Epilepsy?

Epilepsy affects people in different ways. Not everyone experiences every epilepsy stage. Furthermore, a person’s seizure symptoms may vary from other people.

Before the Seizure – Aura

An aura is like a warning sign. Not everyone with epilepsy experiences this first phase, which involves changes to smell, taste, vision, hearing and emotions. The extent to which awareness becomes impaired can vary. An aura is a small, focal (partial) seizure that can develop into a larger, general seizure. Auras can last anywhere from a few minutes to over an hour.

Common aura symptoms:

  • Arm or leg twitching
  • Bitter or acidic taste
  • Dizziness
  • Hallucinations
  • Head, arm or leg pain
  • Nausea
  • Ringing or buzzing in ears
  • Slurred speech
  • Strange or off smells
  • Strong feelings of happiness, sorrow, anxiety or anger
  • Tingling or numbness
  • Vision loss, blurring or flashing

During the Seizure – Ictus

The ictus stage is the seizure itself. Symptoms of this stage depend on the part of the brain affected. Learn more about focal (partial) and generalized seizures.

Common ictus symptoms:

  • Aimless walking, running or other movements
  • Chewing, opening/closing mouth or lip smacking
  • Confusion
  • Difficulty breathing
  • Dilated pupils
  • Drooling
  • Hearing loss
  • Indifference
  • Memory lapse
  • Numbness
  • Pale or flushed skin
  • Racing heart
  • Stiff muscles
  • Strange sounds
  • Sweating
  • Tremors
  • Twitching
  • Unable to move or speak
  • Unusual or repetitive activities
  • Vision loss, blurring, flashing

After the Seizure – Postictal State

Your brain is in recovery. During the postictal state, you may feel tired or disoriented. How long the postictal state lasts varies, which some people recovering almost immediately.

Common postictal state symptoms:

  • Confusion
  • Difficulty finding words
  • Fatigue
  • Feeling “off” or unwell
  • Feeling scared, embarrassed or sad
  • Headaches
  • Hypertension
  • Memory loss
  • Nausea
  • Soreness
  • Thirst
  • Weakness
  • Changes in behavior or anger

What Is the Prognosis for Epilepsy?

Because you never know when a seizure may happen, an epilepsy diagnosis can cause you to lose some independence. Although there’s no cure, early treatment for epilepsy can help you manage your symptoms and prevent injuries, cognitive decline or even premature death.

Learn more about epilepsy treatment.