Diagnosis and treatment of epilepsy

The correct diagnosis of epilepsy leads to an appropriate treatment.

The first step is to distinguish epileptic seizures from nonepileptic attacks, and to make a precise seizure diagnosis and classification. The next step is to identify the etiology or basic disorders underlying the epilepsy by physical and neurologic examinations, laboratory tests, including EEGs and neuroradiologic examinations. Although the EEG is the most important laboratory examination for the diagnosis of epilepsy, limitations of EEG interpretations must be recognized.

A syndromic classification of the patients, to determine whether they fit known syndromes, should be attempted. If patients do not match a described syndrome, a neurobiologic approach, utilizing genetic, neurophysiological, and neuropharmacologic knowledge, alternatively provides useful information to understand the neurobiologic background of epilepsy.

Both approaches have advantages and disadvantages for diagnosing and treating epilepsy. Both approaches can be used interchangeably with patients with seizure disorders, depending upon their condition. The epilepsy diagnosis, etiology, and seizure-type diagnosis should be reevaluated when seizure control is insufficient with first- and second-line antiepileptic drugs.