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__NOTOC__
__NOTOC__
{{Epilepsy}}
{{Epilepsy}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Fs}}
== Overview ==
== Overview ==
There is no single diagnostic study of choice for the diagnosis of epilepsy, but epilepsy can be diagnosed based on history, [[Symptom|symptoms]] and [[physical examination]] of a patient with [[seizure]] complain. Among the patients who present with clinical signs of [[seizure]], the [[Electroencephalography|EEG]] is the most efficient test for diagnosis. Video-[[EEG]] monitoring is a combination of recording [[EEG]] and clinical behavior of the patient. Although it's more expensive, it is more effective in differentiating different type if [[Seizure|seizures]]. With the first [[seizure]], we should perform laboratory study, imaging study ([[MRI]], [[CT Scan]]), [[EEG]], video-[[EEG]] monitoring and [[Lumbar puncture]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of epilepsy, but epilepsy can be diagnosed based on history, [[Symptom|symptoms]] and [[physical examination]] of a patient with [[seizure]] complain.<ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref>
* Among the patients who present with clinical signs of [[seizure]], the [[Electroencephalography|EEG]] is the most efficient test for diagnosis.
* Video-[[EEG]] monitoring is a combination of recording [[EEG]] and clinical behavior of the patient. Although it's more expensive, it is more effective in differentiating different type if [[Seizure|seizures]].<ref name="pmid12233935">{{cite journal |vauthors=Worrell GA, Lagerlund TD, Buchhalter JR |title=Role and limitations of routine and ambulatory scalp electroencephalography in diagnosing and managing seizures |journal=Mayo Clin. Proc. |volume=77 |issue=9 |pages=991–8 |date=September 2002 |pmid=12233935 |doi=10.4065/77.9.991 |url=}}</ref>


OR
* With the first [[seizure]], in order to reach a diagnosis and find out the [[etiology]] of [[seizure]], we should perform ancillary testing such as:
 
** Laboratory study including:<ref name="pmid18025394">{{cite journal |vauthors=Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J |title=Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society |journal=Neurology |volume=69 |issue=21 |pages=1996–2007 |date=November 2007 |pmid=18025394 |doi=10.1212/01.wnl.0000285084.93652.43 |url=}}</ref>
The following result of [gold standard test] is confirmatory of [disease name]:
*** [[Electrolyte|Electrolytes]]
* [Result 1]
*** [[Glucose]]
* [Result 2]
*** [[Calcium]]
 
*** [[Magnesium]]
OR
*** [[Complete blood count]]
 
*** [[Renal function tests]]
[Name of the investigation] must be performed when:
*** [[Liver function tests]]
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
*** [[Urinalysis]]
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
*** [[Toxicology]] screens
 
** Imaging study including:<ref name=":0" />
OR
*** [[MRI]]
 
*** [[CT Scan]]
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
** [[EEG]]
 
** Video-[[EEG]] monitoring
OR
** [[Lumbar puncture]]<ref name="pmid180253942">{{cite journal |vauthors=Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J |title=Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society |journal=Neurology |volume=69 |issue=21 |pages=1996–2007 |date=November 2007 |pmid=18025394 |doi=10.1212/01.wnl.0000285084.93652.43 |url=}}</ref>
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 16:54, 18 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

There is no single diagnostic study of choice for the diagnosis of epilepsy, but epilepsy can be diagnosed based on history, symptoms and physical examination of a patient with seizure complain. Among the patients who present with clinical signs of seizure, the EEG is the most efficient test for diagnosis. Video-EEG monitoring is a combination of recording EEG and clinical behavior of the patient. Although it's more expensive, it is more effective in differentiating different type if seizures. With the first seizure, we should perform laboratory study, imaging study (MRI, CT Scan), EEG, video-EEG monitoring and Lumbar puncture.

Diagnostic Study of Choice

Study of choice

  • There is no single diagnostic study of choice for the diagnosis of epilepsy, but epilepsy can be diagnosed based on history, symptoms and physical examination of a patient with seizure complain.[1]
  • Among the patients who present with clinical signs of seizure, the EEG is the most efficient test for diagnosis.
  • Video-EEG monitoring is a combination of recording EEG and clinical behavior of the patient. Although it's more expensive, it is more effective in differentiating different type if seizures.[2]

References

  1. ↑ 1.0 1.1 Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  2. ↑ Worrell GA, Lagerlund TD, Buchhalter JR (September 2002). "Role and limitations of routine and ambulatory scalp electroencephalography in diagnosing and managing seizures". Mayo Clin. Proc. 77 (9): 991–8. doi:10.4065/77.9.991. PMID 12233935.
  3. ↑ Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J (November 2007). "Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 69 (21): 1996–2007. doi:10.1212/01.wnl.0000285084.93652.43. PMID 18025394.
  4. ↑ Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J (November 2007). "Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 69 (21): 1996–2007. doi:10.1212/01.wnl.0000285084.93652.43. PMID 18025394.

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