“Well, what else are they going to do ? I ask teenagers, ‘What are your choices?’ They could go in their rooms, close the door, and never come out again. That would be a choice. If you help people discover alternatives and allow them to make their own choices, eventually they can find the best way to deal with their problems. There really isn’t anything to do but to pick yourself up and go on, is there?”But sometimes things don’t go so well. People with epilepsy have to walk a fine line between hope and reality. Life is not always fair, but what are they going to do about it? You just have to deal with it. Counseling often can be very helpful in enabling people to see that.”I saw Karen every week or two at the beginning, but later, as things got better, our meetings would be less frequent. She would call just to let me know how things were going or if there was a problem. We got through her first date (she learned that girls with epilepsy could date and be attractive, like everyone else). We discussed who you tell about your epilepsy and when. She didn’t tell every date, but when she began to be serious about one person she made certain that he knew about her seizures. She told her close friends and also the coach of her team.”Now Karen is in college. She first went to junior college to prove to her father that she could do it, and then he agreed to let her transfer out-of-state. She is doing very well. She now has a good self-image. Her seizures are under control, although there is still an occasional seizure when she tests the limits.”*223\208\8*

The EEG is often thought to be able either to prove, or to exclude a diagnosis of epilepsy, but this is rarely possible. A single, routine EEG is likely to show any abnormal (and therefore helpful) activity in only about half of those who have had a tonic-clonic (grand mal) seizure.

If further, or longer duration EEGs are done, the yield increases. It must therefore be clearly understood that the EEG does not prove, nor disprove the diagnosis of epilepsy. There is one important exception to this, and this is with a type of epilepsy called non-convulsive status epilepticus. This may present with bizarre or confused behaviour with semi-purposeful, almost automatic movements. It may be difficult to decide whether this behaviour is epilepsy, but if it is, the EEG helps make the diagnosis

The EEG also is not a good guide to either the activity or prognosis of epilepsy. There is one type of epilepsy, however, in which the EEG is particularly useful—this is typical absence epilepsy (petit mal). In this epilepsy syndrome the frequent seizures may be so brief and subtle that some time may elapse before they are recognized. In children with typical absences, the EEG almost always shows a seizure discharge, which may be induced by hyperventilation, and even more easily after deprivation of sleep.

The EEG is usually not helpful in identifying a cause. Occasionally, however, the EEG may show marked differences between the two sides of the brain, such as a slow wave discharge arising from one particular area. This suggests the presence of a structural abnormality as the cause of the patient’s epilepsy. However, structural abnormalities are best investigated by imaging techniques (brain-scans). These are, after the EEG, the most commonly used investigation in epilepsy.

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