Diagnosis

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The diagnosis of epilepsy requires the presence of recurrent, unprovoked seizures; accordingly, it is usually made based on the medical history. EEG, brain MRI, SPECT, PET, and magnetoencephalography may be useful to discover an etiology for the epilepsy, discover the affected brain region, or classify the epileptic syndrome, but these studies are not useful in making the initial diagnosis.

Long-term video-EEG monitoring for epilepsy is the gold standard for diagnosis, but it is not routinely employed owing to its high cost and inconvenience. It is, however, sometimes used to distinguish psychogenic non-epileptic seizures from epilepsy.

Convulsive or other seizure-like activity, non-epileptic in origin, can be observed in many other medical conditions, including:

* psychogenic non-epileptic seizures (often wrongly called "pseudoseizures")
* tics
* syncope (fainting)
* narcolepsy
* cataplexy

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* parasomnias
* breath-holding spells of childhood
* non-epileptic myoclonus
* hypoglycemia and associated neuroglycopenia
* opsoclonus
* hyperekplexia
* paroxysmal kinesiogenic dyskinesia
* infantile gratification / masturbation (onanism)
* repetitive behaviors

Neurologists are often called upon to distinguish among the above diagnoses and epilepsy.

Epilepsies are classified five ways:

1. By their first cause (or etiology).
2. By the observable manifestations of the seizures, known as "semiology."
3. By the location in the brain where the seizures originate.
4. As a part of discrete, identifiable medical syndromes.
5. By the event that triggers the seizures, as in primary reading epilepsy.

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