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There are many types of epilepsy syndromes, and reaching the right diagnosis can be very challenging.

Having a neurologist specializing in epilepsy (epileptologist) involved in your care will significantly help in providing the right diagnosis and treatment. To ensure the most comprehensive epilepsy care is offered, involvement of numerous specialists and departments is required. In addition, finding the right diagnosis can be lengthy and require a lot of navigating through health care systems. Our team is committed guiding you through this journey. Our physicians offer you the best possible treatment available, starting at your first consultation.

At our epilepsy clinics an epileptologist will perform a thorough health exam and interview. The information you provide here is very important in helping the physician begin planning your care. Offering the most suitable treatment often requires in-depth investigating of the type of epilepsy you have along with understanding all aspects of your health.

Acquiring this detailed information may involve recommendations for further diagnostic tests. In this consultation, other options also may be suggested, such as vagus nerve stimulation or surgical evaluation.

Many types of radiological procedures are available to help physicians gain a better understanding of what is happening the inside the body. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans of the brain are the most beneficial radiological tests to learn about epilepsy.

Our comprehensive epilepsy center has access to state-of-the-art radiological services. We are equipped with 3T MRI scanners and provide MRI/PET fusion techniques, allowing us to access to the most comprehensive and up-to-date imaging options available.

CT scanning of the head yields images of the brain by using X-ray and computed algorithms. During the procedure, exposure to a small amount of radiation occurs and a contrast agent may be used. This procedure is safe, speedy, inexpensive and widely available.

CT scans of the brain are often reported as normal in people with epilepsy. These scans prove most useful in helping to identify certain conditions such as stroke, cerebral hemorrhage and tumors.

This test is done as an outpatient.

Using strong magnetic fields and non-ionizing radiation, MRI scanners produce the best images of the contrast between the different soft tissues of the body. This makes it particularly useful when imaging the brain.

Since MRI uses strong magnetic fields and radio pulses, a possibility of disturbing metal implants exists, therefore, the presence of any metal in the body needs to be reported to the technician prior to entering the MRI room. Items that can cause harm are cardiac pacemakers, cochlear implants, vagus nerve stimulators and some medication pumps. Other forms of metal in the body that may cause harm include metal fragments in the eyes, some cerebral aneurysm clips and metal hardware.

MRI is done as an outpatient visit.

Positron emission tomography (PET) scans are used for people with epilepsy to help identify the area(s) of the brain involved with seizure activity. A PET scan generates images showing cell activity known as metabolism.

The scan is able to recognize areas of the brain where metabolism is altered. Such information can identify the precise nature of seizure activity. The information collected from this test can be very useful in evaluating the possibility of surgery as a treatment option for epilepsy.

This is a safe but sometimes lengthy procedure that is performed as an outpatient.

Pregnant women are advised not to have PET scans due to the radioisotope injection used.

Electroencephalographic monitoring (EEG) is by far one of the most valuable tools available to help epileptologists diagnose and treat epilepsy syndromes. To be able to view a seizure and its associated behaviors requires video EEG monitoring. A video camera and an EEG monitor are simultaneously recording constantly. This type of monitoring is performed in the hospital under close medical supervision.

We offer both inpatient and outpatient EEG services. In addition to routine EEG services we provide video EEG monitoring when more detailed clinical information is required. For patients undergoing surgery, we are equipped to perform intracranial EEG monitoring for more precise EEG data.

In diagnosing epilepsy syndromes, it is important to capture seizure activity as it occurs. In this instance, video EEG is helpful. The purpose of video EEG is to capture all the elements of a seizure.

Video EEG telemetry involves recording brain activity and the physical manifestations that accompany the seizure. The information collected helps to give a more accurate diagnosis of the types of seizures experienced, which in turn leads to the most appropriate treatment being implemented.

Video EEG monitoring requires a hospital stay of usually 4-7 days.

A signaling device such as a call button is provided and used whenever the sensation of a seizure, such as auras or any other sign, is felt. Activating the call button alerts the nursing staff and highlights the event in the EEG computer.

Under medical supervision, seizures are provoked. This is done by seizure medications being carefully tapered down by your neurologist and seizure triggers, such as sleep deprivation and exercise, being initiated.

Data from video EEG telemetry can help the neurologist differentiate epileptic from non-epileptic conditions, determine the types of seizures experienced, and where in the brain they begin.

Neuropsychological assessment involves a number of specially designed tests being carried out by a specialist psychologist known as a neuropsychologist. The tests can reveal important information about certain functions of the brain. It is also useful in identifying abnormal brain function and can help determine types of epilepsy, causes and sites of seizures. Neuropsychological testing is often required for surgical evaluation.

Our team of neuropsychologists consists of experts at examining the mental functions of the brain such as memory, learning, intelligence and emotions.

These include tests such as a Wada and intracranial EEG mapping. These procedures are often necessary to determine surgical candidacy. While a Wada does not require a hospital stay, intracranial EEG monitoring requires a surgical procedure, thus necessitating hospitalization.
The purpose of this test is to discover which side of the brain is primarily responsible for language and memory.

It is an invasive procedure requiring an arterial catheter being placed in the femoral artery (in the groin). The catheter is then injected with a powerful medication called a barbiturate. The medication puts one side of the brain (hemisphere) to sleep while the awake side of the brain is tested. Both hemispheres are tested.

EEG monitoring takes place throughout the procedure to monitor for seizure activity and also to ensure the medication not only sedates the hemispheres during testing but also keeps them awake when testing takes place. A neurologist and neuropsychologist will present a series of questions, phrases and pictures specially designed to test memory and language function.

The test can establish which side of the brain is responsible for memory and language. With this information it can be determined if surgery can be performed without affecting these functions.

This test is performed as an outpatient.

Commonly referred to as brain mapping, this is an invasive procedure requiring surgery. The intention of this procedure is to gather more precise data on areas of the brain not obtainable by conventional scalp EEG.

By placing electrodes over the surface of the brain or within the brain, more details are available as to where seizure activity occurs. By knowing this, the neurosurgeon can be more confident in removing the diseased tissue without removing functioning brain tissue.

Electrodes are placed by either a craniotomy or burr holes. A craniotomy is a surgical procedure where the skull is opened by removing a piece of bone. Burr holes are small holes drilled into the skull. Both the insertion and removal of the electrodes are performed in the operating room by a neurosurgeon. Following placement, electrodes are connected to continuous EEG equipment and seizures are monitored in the intensive care unit. Once sufficient seizure activity has been successfully captured, the electrodes are surgically removed. Epilepsy surgery may coincide with electrode removal, thereby completing the surgical procedures. If not, another date will be set for the surgical intervention requiring a second hospitalization.