Usually patients have no signs of epilepsy or ill-health between seizures, and a physical examination may be quite normal. In some patients, signs of neurological disease may point towards a cause for the seizures.

An electroencephalogram (EEG) is a recording of the brain's electrical activity as measured by electrodes stuck on the outside of the scalp. A recording made during the normal interval between seizures in an epileptic often reveals a seizure "signature" – spiky waves on the smooth, regular background pattern of normal brain waves – and can provide important information about the type and location of the seizure. A normal EEG does not rule out the diagnosis of epilepsy, however. During a seizure, abnormal activity tends to be clearly evident on the EEG recording. Certain patients may be admitted to an epilepsy unit for long-term monitoring. Here, a video recording of the patient asleep and awake and an EEG tracing are obtained over many hours, and the two can be compared side by side.

Other investigations, including various blood tests, and CT or MRI scans of the brain help to determine a cause, and are often obtained as part of the workup of a first seizure.

Reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven.

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