Which diagnostic tests are recommended for confirming a diagnosis of temporal lobe epilepsy in primary care?

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 ¹. The definitive diagnostic tests for confirming temporal lobe epilepsy are typically undertaken by these specialists following the referral ¹.

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 ¹. This scan should be carried out within 6 weeks of referral and follow regionally agreed epilepsy MRI protocols ¹. MRI scans are crucial for identifying structural causes often associated with temporal lobe epilepsy ¹. If MRI is contraindicated, a CT scan may be considered ¹.
• 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 ¹. If a routine EEG is normal, a sleep-deprived EEG may be considered ¹. If diagnostic uncertainty persists after routine and sleep-deprived EEGs, an ambulatory EEG (for up to 48 hours) may be considered ¹. It is important to note that EEG should not be used to exclude a diagnosis of epilepsy ¹.