Confirm that the events are epileptic seizures
Not every transient neurological event is epilepsy. A specialist review should consider seizure semiology, witness descriptions, EEG, imaging and the wider differential diagnosis before escalating long-term medication or planning invasive treatment.
- Detailed description of seizure events and recovery
- Routine or prolonged EEG when clinically appropriate
- Brain MRI using an epilepsy-focused protocol when indicated
- Review of possible provoking factors and differential diagnoses
- Classification of focal, generalized or other epilepsy type
Medication treatment should match the epilepsy type and patient
Anti-seizure medication selection depends on seizure type, epilepsy syndrome, age, sex, pregnancy considerations, comorbidities, interactions and previous adverse effects. A second opinion should review exact doses, adherence and reasons previous treatments failed rather than simply counting the number of drugs tried.
Persistent seizures should trigger specialist reassessment
When seizures continue despite appropriate medication trials, an epilepsy center can reassess the diagnosis and determine whether the patient has a potentially treatable focal epilepsy or another reason for ongoing seizures. Delaying specialist evaluation for years can postpone options that require early presurgical work-up.
Presurgical evaluation combines several types of evidence
For selected patients, the goal is to determine where seizures begin and whether that region can be treated without unacceptable neurological harm. Major epilepsy centers combine long-term video-EEG, high-resolution MRI, neuropsychology and selected functional imaging. Invasive EEG may be needed when non-invasive tests do not answer the key localization questions.
Surgery and neuromodulation are selected treatment branches
When a resectable epileptogenic focus is identified, surgery can include temporal or extratemporal resection, selective procedures, disconnection surgery or minimally invasive techniques in selected cases. When resection is not appropriate, options such as vagus nerve stimulation or other neuromodulation may be discussed. The expected goal may be seizure freedom or meaningful seizure reduction depending on the individual case.
What to send for an international epilepsy review
A German epilepsy center needs the evidence behind the diagnosis and treatment history, especially if surgery is being considered.
- Seizure history, frequency and typical event description
- Current and previous anti-seizure medications with doses
- Reasons previous medications were stopped
- EEG and video-EEG reports
- MRI images and reports
- PET/SPECT or neuropsychology reports if already performed
- Prior epilepsy surgery or stimulation records
- A clear question: diagnosis review, medication strategy or presurgical evaluation
Official sources
Sources last checked 2026-08-31. Clinical pathways, eligibility and hospital procedures can change; confirm current requirements directly with the treating center.