Advanced Diagnostics

Our team uses a variety of diagnostic methods and tests to obtain information about seizures. We begin by taking the patient’s complete medical history and by conducting a physical examination. We also seek a witnessed description of the patient’s seizures from a family member or other observer. Additional tests include:

Continuous video/EEG monitoring

an extended process in which electrical brain activities and seizures or other abnormal behaviors are recorded. The video/EEG monitoring requires a hospital stay in the epilepsy monitoring unit. Electrodes are placed on the scalp so that electrical activity in the brain can be measured. This monitoring allows observation of clinical behavior and EEG activity simultaneously during a seizure. Careful analysis of activity during and between seizures can provide critical information about where the seizure starts and spreads.

Electroencephalogram (EEG)

a technology that measures electrical brain activity and certain abnormalities. Electrodes are placed on the scalp so that electrical activity in the brain can be measured.

Functional Magnetic Resonance Imaging (fMRI)

a painless, noninvasive diagnostic test that provides a series of images that capture blood oxygen levels in parts of the brain that are responsible for movement, perception and cognition. Functional MRI, which reveals the brain in action, differs from standard MRI, which provides a static image. Images from fMRI help physicians determine the location of brain abnormalities in relation to areas of the brain that are responsible for speech, memory and movement.

Magnetic Resonance Imaging (MRI)

a painless, noninvasive diagnostic test that provides a detailed view of the brain’s soft tissue. MRI images can identify structural brain abnormalities that may be the cause of a patient’s epilepsy. An MRI machine creates images by using a powerful magnetic field, radio waves and a computer. The images are taken in slices, from the side, front, or bottom.

Neuropsychological Testing

an evaluation of a patient’s level of brain functioning, including memory and language. The testing is conducted by a neuropsychologist. Results are correlated with diagnostic imaging and EEG.

Positron Emission Tomography (PET)

a test that allows a physician to study how glugose is metabolized in the brain. A small amount of radioactive glucose is first injected into the bloodstream. A technologist then takes images with a PET scanner. A scan that is taken while a patient is experiencing a seizure typically shows an increased use of glucose in the brain. The images can help the physician locate structural abnormalities or dysfunctional areas within the brain.

Single-Photon Emission Computed Tomography (Ictal SPECT)

a noninvasive test that provides information about blood flow to brain tissue. Analyzing blood flow to the brain can help determine how specific areas are functioning. Blood flow to an area of the brain during a seizure increases, while blood flow to an area of the brain before or after a seizure can decrease.

Surgical Tests

tests that might be necessary if the seizure focus cannot be located with EEG or other diagnostic tests. Surgical tests use subdural electrodes, which are placed directly on or in the brain through a hole in the skull. After the electrodes have been placed, the patient’s head is bandaged, and the patient is taken to the epilepsy monitoring unit. The electrodes are connected to an EEG machine through small wires, and precise information about the patient’s seizures is recorded.

Wada Test (Intracarotid Amytal Test)

A minimally invasive test that is used to determine which side of the patient’s brain is dominant for language and memory function. The information helps physicians determine whether surgery can be performed safely and without impairing the patient’s language abilities. During the Wada test, sodium amytal, a short-acting barbiturate, is injected into the left or right carotid artery, thereby putting half of the brain to sleep. The patient is then asked to identify pictures, words, objects or numbers. The patient continues answering questions after the drug has worn off. The process is then repeated on the other side. Results of the Wada test are used in conjunction with the neuropsychological testing to help identify memory and language deficits and to predict postoperative outcome.

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