While recurring seizures are the main symptom of epilepsy, they aren’t the disease itself. This makes it important to work with specialists who can identify the exact location in your brain that causes those seizures. That may take time, but at the Ohio State Comprehensive Epilepsy Center, we’ll give you the support and encouragement needed to complete a detailed diagnosis because we’ve seen the tremendous success that follows.

Seizures differ in type and intensity

There’s not one type of epileptic seizure, and each person can experience seizures differently.

• One person may suffer blank stares that last only a few seconds, while another person will lose consciousness or have muscle spasms and uncontrollable movements for several minutes. Some individuals with epilepsy describe “strange” sensations or emotions.
• It’s also possible that a person behaves differently or becomes disoriented during a seizure.
• Often, the person is only partially aware that a seizure even occurred. Patients sometimes describe a feeling of lost time, anxiety or a sense of déjà vu.
• Some patients, particularly those with reflex epilepsy, may be able to identify the events or “triggers” that consistently occur before a seizure, such as flashing lights or certain noises. Knowing these triggers may help people avoid them or recognize when they’re at risk of having a seizure.
• It’s possible for a person with epilepsy to have more than one kind of seizure.

How is epilepsy diagnosed?

Seizures don’t occur on cue when you’re at a doctor’s appointment, so the epilepsy specialists at The Ohio State University Wexner Medical Center will use advanced diagnostic tools to confirm whether you have epilepsy or another disorder with similar symptoms.

The goal of any testing is to help us understand the unique electrical activity of your brain, map where seizures start and understand what triggers your seizures. We may be able to accomplish this relatively quickly, but sometimes tests will need to be repeated to get the most detailed diagnosis possible. As we gather new information, it’s also possible that your initial diagnosis may change.

Collecting detailed information

The initial diagnosis process begins with collecting your complete medical history and a description of your seizures and potential triggers. We’ll then choose the most appropriate test or tests, which may include:

• Electroencephalogram (EEG) – a brief brain wave recording to look for activity that would indicate likelihood of epilepsy.
• Magnetic resonance imaging (MRI) – uses a strong magnetic field and radio waves to create detailed images of the brain’s structure to allow our physicians to evaluate whether structural lesions or other abnormalities may be causing your symptoms.
• Single photon emission computed tomography (SPECT) – a type of scan that detects blood flow changes in the brain and shows the “hotspot” in the brain where the seizure starts.
• A positron emission tomography (PET) scan – small amounts of radioactive material are injected into the patient’s vein, allowing us to study the brain’s use of oxygen or sugar (glucose).

Epilepsy Monitoring Unit makes Ohio State stand out

A tremendous advantage found at Ohio State’s Comprehensive Epilepsy Center is our state-of-the-art Epilepsy Monitoring Unit (EMU). Designed to simulate real-life situations that may trigger a seizure, the EMU is located at our Brain and Spine Hospital.

Stays in the EMU last three to five days, which allows us the time to understand your individual seizures by triggering one in a controlled medical environment. You’ll be monitored throughout your stay, so both you and your loved ones can feel at greater ease. In fact, you’ll have access to specially trained registered nurses and patient care assistants around the clock. You can also wear whatever comfortable clothes you choose and may bring any items from home that you want for entertainment.  

At the beginning of your stay, we’ll conduct a physical exam and ask questions about your medications, medical history and seizures. During the monitoring period, we may reduce medications you’re taking, increase your physical activity, deprive you of some sleep, flash bright lights in your eyes or guide you in breathing fast and deep.  

Throughout your supervised stay, you’ll have an IV in place so that we can quickly give you medication to stop seizures if they become too long or frequent. You’ll also wear electrodes on your head that are connected to a video-EEG monitor by a cable.

EMU tests and results

The primary test we perform in the Epilepsy Monitoring Unit (EMU) is called continuous video-EEG (electroencephalograph) monitoring. The video allows us to see and hear what you’re doing or experiencing during a seizure, while the EEG captures the electrical activity in your brain. Comparing all of this information during the same period of time can give us a better understanding of your triggers, the parts of your brain that are involved and the types of seizures you have.  

There are additional tests we can perform while you’re in the EMU if we need more information. We can inject tracers (a mildly radioactive liquid) into the brain, which helps us visually locate the source of seizures with a CT scan, or implant EEG leads to record directly from the brain itself. 

Each day of your EMU stay, an attending doctor, resident or nurse practitioner will provide updates on our findings, explain next steps and answer your questions.  

After your stay in the EMU, your doctor will review all test results, arrange follow-up appointments and recommend treatment options.