Editing Epilepsy (section)

===Tests===
<!--EEG Same as seizure  -->
[[File:EEG Recording Cap.jpg|thumb|upright=1.4|An [[electroencephalography|EEG]] can aid in locating the focus of the epileptic seizure.l]]The diagnostic evaluation of epilepsy begins with confirming whether the reported event was in fact a seizure. A detailed clinical history remains essential, supported by eyewitness accounts and, when possible, video recordings. The initial assessment aims to distinguish epileptic seizures from common mimics such as [[Syncope (medicine)|syncope]], [[psychogenic non-epileptic seizures]], or transient ischemic attacks.

Following clinical evaluation, selected tests may be used to rule out acute causes and seizure mimics. A 12-lead [[Electrocardiography|electrocardiogram]] (ECG) is recommended for all individuals presenting with a first seizure, to screen for [[cardiac arrhythmias]] and other cardiovascular conditions that may resemble epilepsy. Blood tests may be performed to identify metabolic disturbances such as [[hypoglycemia]], [[Electrolyte imbalance|electrolyte imbalances]], or renal and hepatic dysfunction, particularly in acute settings.<ref name="NICE2022">{{Cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK581165/ |title=Epilepsies in children, young people and adults |date=2022 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-4513-9 |series=National Institute for Health and Care Excellence: Guidelines |location=London |pmid=35700280}}</ref>

Once epilepsy is suspected, [[electroencephalography]] (EEG) is used to support the diagnosis, classify seizure types, and help identify specific epilepsy syndromes. A routine EEG may include activation techniques such as [[hyperventilation]] or photic stimulation. However, a normal EEG does not rule out epilepsy. When initial EEG findings are inconclusive, further studies such as sleep-deprived EEG, ambulatory EEG, or long-term video EEG monitoring may be considered.<ref name="NICE2022" />

Neuroimaging, usually with [[magnetic resonance imaging]] (MRI), is recommended to detect structural causes of epilepsy. If MRI is contraindicated or unavailable, [[computed tomography]] (CT) may be considered. Imaging should be interpreted by radiologists with expertise in epilepsy.<ref name="NICE2022" />

Additional tests may be guided by clinical context. [[Genetic testing]] may be considered in individuals with early-onset epilepsy, developmental delay, or features of a known genetic epilepsy syndrome. Testing for neuronal antibodies may be appropriate in suspected cases of [[autoimmune encephalitis]], particularly when seizures are new-onset, rapidly progressive, or resistant to standard treatment. Metabolic testing may be pursued in infants or children with unexplained epilepsy, especially when developmental regression or multisystem involvement is present.<ref name="NICE2022" />

Serum [[prolactin]] may occasionally be measured after a suspected seizure, particularly to help distinguish epileptic seizures from non-epileptic events. While it can be elevated following certain seizure types, the test lacks sufficient sensitivity and specificity and is not recommended for routine use.