Transcript: Many conditions can imitate seizures, so doctors use four different methods to help diagnose epilepsy.  Some people worry that they or a relative have epilepsy because of daydreaming, excessive sleepiness, fainting spells, warning strokes, tremors, or other conditions that look like seizures. But these symptoms can be caused by diseases other than just epilepsy.  To make a proper diagnosis of epilepsy, doctors use four methods: history, exam, EEG, and MRI.  The first method used is the neurological history, when the doctor is given a clear description of any past seizure activity.  Most seizures have a clear start and finish, last from seconds to a few minutes, occur at seemingly random times, and comprise certain sensations and behaviors that clinicians can recognize.  Patients may not remember their behavior during seizures, so descriptions from observers are very important.  A physical exam cannot uncover epilepsy, but it can show problems indicating that a part of the brain isn’t working properly, and may be generating seizures.  The third method of diagnosis is an EEG, or electroencephalogram, which measures the patient’s brain waves.  A. The brain produces electricity, which can be measured by wires glued onto the scalp.  B. The EEG records and charts these electrical voltages.  The normal up and down movements of these voltages create the wave-like pattern seen here.  A. Spikes on the EEG are markers of hyper-excitable parts of the brain, which mark potential locations where seizures may arise.  B. The presence of spikes helps to confirm a diagnosis of epilepsy, provided the history is also convincing. Some people have EEG spikes without seizures, so a history of seizures is needed to make a diagnosis.  In a patient with epilepsy, an EEG recorded between seizures has a 50-50 chance of seeing spikes, so a normal EEG doesn’t rule out a diagnosis of epilepsy.  The fourth diagnostic method used is neuroimaging.  Neuroimaging looks at the structure of the brain.  The two most commonly used neuroimaging tests are a brain CT scan and a brain MRI.  A CT is faster, easier and less expensive, but an MRI shows more detail.  Neuroimaging cannot show abnormal electrical activity or a seizure itself, but it can show physical changes in the brain, which may suggest the reason for the seizures.  This MRI shows bruising of both frontal lobes, in a case of head trauma. Although head trauma without loss of consciousness rarely causes epilepsy, serious head trauma with prolonged unconsciousness sometimes does.  People with seizures worry that they might have a brain tumor, but fortunately tumors actually cause only a small percentage of seizures.  This MRI shows a region of stroke, which results from a sudden blockage of blood flow to the brain.  Seizures don’t cause strokes, but strokes can lead to seizures.This happens when brain cells are injured and can no longer control their electrical activity. One stroke can cause ongoing seizures for years.    Abnormal blood vessels in the brain like aneurysms, arteriovenous malformations, or cavernous angiomas can all cause seizures. The malformation itself doesn’t generate seizures, but the irritated brain cells nearby may.  This is a congenital abnormality in the brain called a dysplasia, or a “birthmark in the brain.” A dysplasia is made up of normal cells in an abnormal location. Dysplasias don’t grow, but they are a common cause of epilepsy.  Your doctor will combine information from your history, exam, and if needed, EEG and MRI to determine if you have epilepsy. A diagnosis cannot always be made, but if diagnosis is difficult, you can be referred to an epilepsy specialist for a more detailed evaluation.  “The movies in this series can be viewed in any order.  If you wish to watch these clips in their original sequence, the next clip is, “How to Diagnose Epilepsy?