Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
In primary care, the primary recommendation for a suspected first seizure, which could indicate temporal lobe epilepsy, is an urgent referral (within 2 weeks) to a clinician with expertise in assessing first seizures and diagnosing epilepsy NICE NG217. The definitive diagnostic tests for confirming temporal lobe epilepsy are typically undertaken by these specialists following the referral NICE NG217.
The key diagnostic tests recommended for confirming a diagnosis of epilepsy, including temporal lobe epilepsy, by specialists are:
- MRI Scan: An MRI scan is offered to children, young people, and adults diagnosed with epilepsy, unless they have idiopathic generalised epilepsy or self-limited epilepsy with centrotemporal spikes NICE NG217. This scan should be carried out within 6 weeks of referral and follow regionally agreed epilepsy MRI protocols NICE NG217. MRI scans are crucial for identifying structural causes often associated with temporal lobe epilepsy NICE NG217. If MRI is contraindicated, a CT scan may be considered NICE NG217.
- Electroencephalogram (EEG): If the person's history and examination suggest an epileptic seizure and epilepsy is suspected, a routine EEG carried out while awake is considered to support diagnosis and provide information about seizure type or epilepsy syndrome NICE NG217. If a routine EEG is normal, a sleep-deprived EEG may be considered NICE NG217. If diagnostic uncertainty persists after routine and sleep-deprived EEGs, an ambulatory EEG (for up to 48 hours) may be considered NICE NG217. It is important to note that EEG should not be used to exclude a diagnosis of epilepsy NICE NG217.