If Your Patient is a Young Adult with Seizures, Run These Lab Tests

Seizures are episodes of abnormal brain activity caused by neuron over-activation. Neurons are the cells in the brain that receive and send messages to the rest of the body. When these cells have excess stimuli, a seizure can occur, causing uncontrolled body movements and changes in behavior. There are two main categories of seizures: partial and generalized. Seizures affect 2.9 million adults in the United States and 456,000 children. This article focuses primarily on seizures in young adults. Common causes of seizures in this age group include:

• Infection
• Genetics
• Autoimmune disorders
• Metabolic disorders 
• Structural changes to the brain

Prompt diagnosis and management of seizures can prevent complications, avoid further damage to the brain, and help promote quality of life. This article provides a functional medicine guide to lab testing for diagnosing and managing seizures in young adults.  

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Initial Assessment and History-Taking

When a young adult first presents with seizures, a thorough history and physical is very important to investigate underlying causes. A comprehensive history should include information about:

• Family history of seizures
• History of infections, head injuries, or metabolic abnormalities
• Alcohol
• Recreational drug use
• Seizure characteristics (length, frequency, symptoms after seizure)
• Medications 

A thorough physical and neurological examination should be performed in addition to reviewing the above. A physical exam involves assessing the skin, heart, lungs, and abdomen for signs of systemic disease. Assessing the patient’s neurological status may involve the Glasgow Coma Scale, which can be used to determine the patient’s level of consciousness. Mental status can be evaluated using a mental status exam. This involves checking orientation to time, place, and person, as well as how awake the young adult is. A mini mental status examination (MMSE) can be performed if further information is needed. 

Assessing the cranial nerves can detect any abnormalities, as the cranial nerves innervate the body and can be affected by seizure activity. Assessing gait and deep tendon reflexes is also helpful in identifying any problems with the motor (movement) neurons. 

The Essential Lab Tests for Diagnosing Seizures in Young Adults

Strategic lab testing is a critical component of caring for a young adult experiencing seizures. A variety of tests can provide information about contributing factors. 

Complete Blood Count (CBC)

A CBC serves as an overview of the cells in the blood. It can identify the amount, color, and size of red blood cells, hemoglobin, and levels of white blood cells (“white blood cell count”). These numbers can help identify anemia and infection. Infections like meningitis (infection of the tissues surrounding the brain) can cause seizures. Testing with a CBC can help investigate possible underlying causes of seizures. 

Basic Metabolic Panel (BMP)

A basic metabolic panel (BMP) evaluates electrolytes, glucose, and kidney function. Electrolytes (e.g., sodium) have effects throughout the body, and an imbalance can cause systemic effects. This includes changing neuronal activity, which may result in a seizure. Additionally, evaluating glucose levels in the blood can help determine if high or low blood sugar levels have contributed to seizure activity.  

Liver Function Tests (LFTs)

The liver performs vital bodily functions, including metabolizing medications, protein production, and clearing toxins from the body. Using liver (hepatic) function tests (LFTs) to see how it is functioning can help identify the root causes of a seizure. Liver enzyme levels can determine if the liver is healthy. Bilirubin, a compound produced when red blood cells break down in the body, can also be measured. High levels are associated with impaired liver function (e.g., jaundice). These lab tests can help the provider determine if the liver contributed to a seizure via conditions like toxicity or hepatic encephalopathy. 

Toxicology Screen

When treating a young adult patient with seizures, testing for substances in the blood that can contribute to seizures is essential. Some drugs and toxins cause seizures, and others lower the seizure threshold, making abnormal neuron activity more likely. Testing the blood for alcohol, cocaine, prescription medication overdose, and other recreational drugs (e.g., amphetamines) can help identify underlying causes of seizures. Toxicology testing is particularly relevant when treating young adults with seizures because substance use is common in this age group. 

Blood Glucose and Hemoglobin A1c

Glucose testing and long-term blood sugar control values (Hemoglobin A1c) are important labs for many patients, but these tests are especially useful when treating a young adult with seizures. High glucose levels are correlated with an increased risk of seizures. Additionally, dysregulated blood can worsen the intensity of a seizure. An accurate picture of a patient’s glucose regulation can reveal possible seizure triggers and provide more information about their overall health. Utilizing these tests can help to identify undiagnosed and poorly controlled diabetes. 

Serum Calcium and Magnesium

Minerals play a central role throughout the body, including proper nerve function. When these levels become unbalanced, the patient can be at risk for seizures. Testing serum calcium and magnesium can help identify conditions that may contribute to seizures, such as malnutrition, endocrine dysfunction, and gastrointestinal disorders. 

Electrolyte Panel

Young adults with seizures may also be at risk for electrolyte imbalances due to dehydration or altered kidney function. Testing sodium, potassium, and chloride levels can help identify metabolic or renal causes of seizures. 

Thyroid Function Tests (TFTs)

Thyroid health impacts many systems in the body, including neurological health. Measuring specific aspects of thyroid function can help detect if the patient has excessive thyroid function (hyperthyroidism) or depressed thyroid function (hypothyroidism). Both of these conditions can contribute to seizures in young adults and can be treated with medication. Useful tests include T3, T4, and thyroid-stimulating hormone (TSH). 

Lumbar Puncture and CSF Analysis (If Indicated)

In some specialized cases, analyzing the cerebrospinal fluid (fluid surrounding the brain and spinal cord) can help identify underlying causes of seizures. Testing this fluid can detect signs of infection or inflammation in the central nervous system (brain and spinal cord). Seizures can be a warning sign of severe infections like meningitis or encephalitis (infections of the tissues surrounding the brain or spinal cord). These tests should be performed on patients with a high fever, altered mental status, or other signs of infection. 

Additional Specialized Tests

The following tests may be helpful for these patients as well:

EEG (Electroencephalogram)

An electroencephalogram (EEG) measures electrical activity in the brain and can help detect abnormal neuronal activity. Finding patterns of brain activity can help identify seizures and aid in diagnosis. This specialized test can be helpful if other lab testing does not uncover the cause of seizures. 

MRI or CT Scan

Imaging can provide information about the brain’s structure in a patient with seizures. Magnetic resonance imaging (MRI) and computer tomography (CT) are detailed scans of the soft tissues that can reveal tumors, vascular malformations, and other anatomical abnormalities. These studies should be ordered if there is suspicion of brain injury or soft tissue malformations, or if seizure activity is unexplained. 

Genetic Testing (If Indicated)

If the young adult experiencing seizures has a family history of epilepsy, recurrent seizures, or unknown seizure causes, genetic testing may be indicated. Specialized genetic testing can identify genetic mutations associated with epilepsy and other seizure disorders. 

Understanding Test Results and Follow-Up

A step-wise approach to examining a young adult with seizures can help the provider make a diagnosis. The neurological and physical examination can be compared with the patient history and lab results to identify an underlying cause. It is important to rule out reversible seizure causes, including metabolic/electrolyte imbalances and substance use. 

Next Steps in Patient Care

Many cases of seizures in young adults require referral to a specialist such as a neurologist. Detailed diagnostic care is often necessary if the immediate cause of seizures is not evident or reversible. 

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Key Takeaways

• A detailed history, physical, and neurological exam are essential for identifying potential seizure causes, including family history, substance use, and metabolic abnormalities.
• Critical tests like CBC, BMP, liver function, toxicology screen, and glucose monitoring help detect underlying factors such as infections, electrolyte imbalances, or substance use that may trigger seizures.
• EEG, MRI/CT scans, and genetic testing are recommended if the cause of seizures remains unclear after initial evaluations.
• A tailored diagnostic approach combining lab results with clinical history enables targeted interventions, prioritizing the identification of reversible causes (e.g., metabolic disorders, toxins).
• Prompt diagnosis and specialist referrals (e.g., to a neurologist) can prevent complications and improve outcomes for young adults with seizures.
• Early intervention can prevent future seizures and reduce the risk of complications.
• Healthcare providers should utilize a comprehensive testing strategy when evaluating young adults with seizures.