Abstract
Diagnosing epilepsy consistently presents numerous challenges, with misdiagnosis being common, occurring at rates of 4.6–30% depending on the study (Smith D, QJM, 1999). Epilepsy is a clinical diagnosis, and thorough history-taking through detailed seizure description is the core element for diagnosing seizure type; EEG and brain MRI serve as supportive tools for diagnosing the epilepsy type, syndrome, and structural etiology (Scheffer IE, Epilepsia, 2017). Eliciting seizure history through descriptions provided by eyewitnesses or by the patients themselves has limited reliability due to various factors (Muayqil T.A, BMC Neurol, 2018). Consequently, guidance on home video monitoring—a widely applicable, low-cost tool—serves as a valuable source of information for physicians (Lorenzo R, Neurol. Sciences, 2020). The level of neurologists' knowledge regarding seizure semiology also affects the quality of history-taking (Seneviratne U, Epilepsia, 2012). Therefore, eliciting seizure history using seizure semiology checklists and classification systems can help improve diagnostic accuracy (Fisher RS, Epilepsia, 2017). Scalp EEG not only aids in diagnosis but also assists in seizure monitoring and epilepsy syndrome classification. The ILAE's draft recommendations address minimum technical standards for routine EEG recording to increase accuracy and reliability (Peltola, 2022). Adding inferior temporal electrodes increases sensitivity in detecting epileptiform discharges in temporal lobe epilepsy (Seeck M, Clin Neurophysiol, 2017). Sleep-deprived EEG—easily performed on an outpatient basis and cost-effective—increases sensitivity in detecting generalized discharges (J P Leach, J Neurol Neurosurg Psychiatry, 2006). Sleep EEG increases the detection rate of epileptiform discharges (Meritam P, Clin Neurophysiol, 2018), and in particular, may be widely applicable through nap-time EEG recording in Vietnam. Brain MRI helps identify structural causes of epilepsy and is essential when epilepsy surgery is being considered. A high-resolution, isotropic imaging protocol with 3D T1 and FLAIR reconstruction at 1-millimeter resolution and 2D T2 imaging at under 1-millimeter resolution (the HARNESS-MRI protocol) is recommended and can be performed on a 3T MRI scanner or, at minimum, a newer-generation 1.5T scanner, to detect focal cortical dysplasia, hippocampal atrophy, tubers, hamartomas, or scarring, among other findings. To optimally evaluate the internal structure of the hippocampus, spin-echo sequences perpendicular to the long axis of the hippocampus should be obtained. Additional sequences may include: gadolinium-enhanced imaging to evaluate for tumor, vascular malformation, or infection; and T2* sequences to detect iron deposition, blood products, and calcification (Andrea B, Epilepsia, 2018).
