Partial Epilepsies Workup

Updated: Feb 22, 2016
  • Author: Alberto Figueroa Garcia, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Workup

Approach Considerations

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

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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
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Computed Tomography

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

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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.

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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.

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