Neurological Exam for Epilepsy

Reviewed by: HU Medical Review Board | Last reviewed: November 2021

Epilepsy is a disease in which nerve cells in the brain do not work correctly. When the nerve cells do not work, it can cause a seizure. Different types of seizures result when nerves in the brain misfire. Many things can cause epilepsy, including genetics, infection, brain tumor, stroke, or a head injury.1,2

If someone has a seizure, doctors will order a series of tests, including a neurological exam.

A neurological exam is a series of tests that look at how your brain and nerves work. This test is usually done by a neurologist. This is a doctor who specializes in the brain and nervous system.3

Brain and nerve exams

Your neurologist will check a wide variety of functions during your brain and nerve exam (neurological exam), such as:3,4

  • Memory and thinking (cognition)
  • Cranial nerve function (these are nerves in the brainstem that control many parts of the body)
  • Muscle strength, reflexes, and movement
  • Sensations
  • Coordination, balance, and walk (gait)

By talking to you, the doctor can gather information about your mood, speech, ability to remember words and name objects, ability to concentrate, and more. There will also be simple tests to measure your balance, strength, reflexes, walk (gait), and coordination.3,4

These tests can give your neurologist a sense of the overall health of your nervous system. They are not a measure of intelligence.

What happens during these tests?

Several simple actions are used to test how well someone’s brain and nerves are working. Examples include:3,4

  • Walk in a straight line, balance on 1 foot or on tip-toe, or walk with both feet on the ground and the eyes closed.
  • Touch a finger to your nose and then to the doctor’s finger.
  • Grip the doctor’s hand.
  • Hold your arms out straight for 10 seconds with your eyes closed.
  • Push against the doctor with your arms or legs.
  • Follow an object with your eyes.
  • Smile, turn your head, shrug your shoulders, stick your tongue out, or open and close your eyes.
  • Answer questions about the day of the week, time of day, what you had for breakfast, or a recent vacation.
  • Do math.
  • Remember the names of objects.

The doctor may also tap your knees, arms, or feet with a rubber hammer to check your reflexes.

During follow-up visits, the results of the first neurological exam will be used as a baseline. Changes in these tests over time help your doctor understand your epilepsy better. This baseline also helps your doctor know if your anti-seizure drugs are causing unwanted side effects.3

Other tests for epilepsy

To diagnose epilepsy, your doctor will also order other tests and conduct a physical exam. The other tests may include:1,2

  • EEG (electroencephalogram)
  • Urinalysis
  • Brain imaging tests
  • Blood tests
  • Spinal tap (lumbar puncture)
  • Hospital monitoring
  • Genetic testing

Once you have been diagnosed with epilepsy and are taking anti-seizure drugs, you may need regular blood work.

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