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