Partial Epilepsies Workup

Author: Alberto Figueroa Garcia, MD; Chief Editor: Helmi L Lutsep, MD more...

Updated: Jun 7, 2011

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Approach Considerations
Laboratory Studies
Computed Tomography
Magnetic Resonance Imaging
Electroencephalography
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Approach Considerations

Laboratory studies, neuroimaging studies, and electroencephalography (EEG) are used in the assessment of partial epilepsies.

Laboratory Studies

Because the type of seizure (partial vs generalized) often is not clear early on, investigate various possible causes for the seizures, including structural abnormalities and toxic and metabolic disturbances. Perform the following test, preferably at seizure onset:

Metabolic panel
Cerebrospinal fluid examination, if CNS infection is suspected (eg, fever, neck rigidity, mental status changes)
level of anticonvulsant medication

Computed Tomography

A CT scan of brain without contrast is readily and rapidly available and appropriate in an emergency setting.

Magnetic Resonance Imaging

MRI of the brain, with and without contrast, delineates structural detail and pathology. Obtain a special temporal lobe cut for mesial temporal sclerosis.

Electroencephalography

EEG is extremely useful to confirm the diagnosis of epilepsy and to confirm a partial onset. The sensitivity of routine EEG is low but increases somewhat with repeated recordings. When seizures are frequent (>1/wk), EEG video monitoring allows a definitive diagnosis of epilepsy, including its type.

Childhood epilepsy of occipital paroxysms

EEG shows sharp waves with a maximum occipital negativity. These often occur in long bursts of spike-wave complexes, and are markedly activated by eye closure.

Benign childhood epilepsy with centrotemporal spikes

EEG findings are centrotemporal sharp waves with a characteristic morphology. They occur in repetitive bursts and are often bilateral. These sharp waves are activated markedly by nonrapid eye movement (non-REM) sleep. (For comparison, see the article Normal Sleep EEG.)

Autosomal dominant nocturnal frontal lobe epilepsy

Interictal EEG may show epileptiform discharges with a frontal predominance, often observed only in sleep.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Alberto Figueroa Garcia, MD Resident Physician, Department of Neurology, University of South Florida College of Medicine

Alberto Figueroa Garcia, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Vikas K Agrawal, MD Attending Neurologist, Medical Director of Stroke Unit, Bronx Lebanon Hospital Center; Clinical Instructor, Albert Einstein College of Medicine

Vikas K Agrawal, MD is a member of the following medical societies: American Academy of Neurology and American Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Specialty Editor Board

Claude G Wasterlain, MD Chair, Department of Neurology, VA Greater Los Angeles Health Care System; Distinguished Professor and Vice-Chair, Department of Neurology, University of California, Los Angeles, David Geffen School of Medicine

Claude G Wasterlain, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Federation for Medical Research, American Neurological Association, Royal Society of Medicine, and Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jose E Cavazos, MD, PhD, FAAN Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director of the San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association

Disclosure: GXC Global, Inc. Intellectual property rights Medical Director - company is to develop a seizure detecting device. No conflict with any of the eMedicine articles that I wrote or edited.

Chief Editor

Helmi L Lutsep, MD Professor, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, Oregon Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

References

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Rudzinski LA, Shih JJ. The Classification of Seizures and Epilepsy Syndromes. CONTINUUM: Lifelong Learning in Neurology. Jun 2010;16(3):15-35. [Full Text].
Sveinbjornsdottir S, Duncan JS. Parietal and occipital lobe epilepsy: a review. Epilepsia. May-Jun 1993;34(3):493-521. [Medline].
Naritoku DK, Warnock CR, Messenheimer JA, Borgohain R, Evers S, Guekht AB, et al. Lamotrigine extended-release as adjunctive therapy for partial seizures. Neurology. Oct 16 2007;69(16):1610-8. [Medline].
Richy FF, Banerjee S, Brabant Y, Helmers S. Levetiracetam extended release and levetiracetam immediate release as adjunctive treatment for partial-onset seizures: an indirect comparison of treatment-emergent adverse events using meta-analytic techniques. Epilepsy Behav. Oct 2009;16(2):240-5. [Medline].
Powell G, Saunders M, Marson AG. Immediate-release versus controlled-release carbamazepine in the treatment of epilepsy. Cochrane Database Syst Rev. Jan 20 2010;CD007124. [Medline].
Benbadis SR. Evaluation for surgical treatment of partial epilepsy: an overview. Wis Med J. 1995;94(9):500-4. [Medline].

This graph illustrates the 2 peaks of incidence of epilepsy: early and late in life.

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