Epilepsy and The Spinal Tap

What Is a Spinal Tap?

One test for epilepsy is a spinal tap (also called a lumbar puncture). This is a procedure in which fluid surrounding the spinal cord (called the cerebrospinal fluid or CSF) is withdrawn through a needle and examined in a lab.

Why Is a Spinal Tap Performed?

A spinal tap may be performed to rule out infections such as meningitis or encephalitis as the cause of epileptic seizures.

Besides being used for epilepsy, testing the CSF can help in the diagnosis of disorders of the chronic inflammatory demyelinating polyneuropathy, central nervous system that may involve the brain, spinal cord, or their coverings (the meninges). Meningitis, multiple sclerosis, Guillain-Barre syndrome, or headaches of unknown origin are a few examples.

The CSF contains glucose (sugar), proteins, and other substances found in the blood. An examination of the fluid will show the number and types of white blood cells, the level of glucose, the types and levels of proteins, and the presence of bacteria, fungi, or abnormal cells.

A spinal tap may also be performed to:

• Measure the pressure around the brain and spinal cord
• Relieve pressure in the head
• Give spinal anesthesia
• Inject dye for an X-ray diagnostic test
• Inject medications (such as baclofen)

NOTE: Testing of the CSF may not be necessary if the spinal tap procedure is done to inject a medication.

What to Expect During a Spinal Tap

Preparation for a spinal tap

• Maintain your regular eating schedule. There are no dietary or fluid restrictions before the test.
• Ask your doctor for specific guidelines about discontinuing alcohol use, aspirin products, and blood-thinning drugs before the procedure.
• Tell your doctor if you are allergic to latex or any medications.
• Please make arrangements for transportation, as you should not drive immediately after the test.

Description of the procedure

You will either lie on your side with your knees drawn as close to your chest as possible and your chin toward your chest or sit with your arms and head resting on a table. After cleaning your back with an antiseptic, sterile cloths (called drapes) will be placed around the area. A local anesthetic (pain-relieving medication) will be injected into the area on your back. You may feel a slight burning sensation. When the area becomes numb, a hollow needle will be inserted in the lower back between two lumbar vertebrae. This sometimes causes a feeling of pressure. The spinal canal will be penetrated and fluid will be collected or medication will be injected. The spinal cord will not be touched by the needle during the test. You may feel some discomfort or have a minor headache. The needle will be removed after the medication has been injected or fluid has been removed. The area will be covered with a small bandage. A blood sample will be taken from a vein in your arm and tested along with the spinal fluid in the lab. If the procedure is done to inject medication, a blood sample may not be taken.

Side effects and risks of a spinal tap

• Approximately 10% to 20% of people develop a spinal headache (one that worsens when sitting or standing).
• The risk of infection is extremely low.
• Occasionally, a small blood vessel is pierced, causing bloody discharge. No treatment is needed.
• The procedure is usually not painful, but momentary twinges of pain may be felt if the needle brushes against nerve tissue.

Care after spinal tap

• Once a spinal tap is completed, you will be instructed to lie flat (the time spent flat after the tap will vary depending on why you received the procedure). A nurse will discuss post-procedure instructions with you and provide the instructions to you in written form.
• Avoid strenuous or vigorous exercise for a day or so following the lumbar puncture.
• If you have a headache, lie down as much as possible and drink plenty of fluids. Contact your health care provider if the headache persists.
• Drink 2 1/2 quarts of liquid the day of the spinal tap and the day after (regardless of headache).

You should contact your referring doctor to let the doctor know that you have had the procedure and that you are waiting for the results.

When to Contact the Doctor After a Spinal Tap

Call your local doctor immediately if after a spinal tap:

• You notice any unusual drainage, including bloody discharge, at the puncture site
• You develop a fever
• Your headache persists
• Your pain symptoms worsen

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