Patient Services

Patient Guide to Procedures:

The Epilepsy Center evaluates and treats epilepsy and seizure disorders. The Center is equipped with state-of-the-art technology for continuous electroencephalographic and video monitoring of seizures. This facility represents one component of a comprehensive evaluation and treatment program for patients with epilepsy. We offer a range of cutting-edge neuro-imaging techniques. Imaging studies are used to evaluate the structure of the brain or to evaluate its function. One or more of these studies may be recommended for diagnosis and treatment.

If you are pregnant or suspect you may be pregnant, the imaging studies can not be performed.

What to expect with each of these procedures:

Magnetic Resonance Imaging (MRI)

789 Howard Avenue, New Haven, CT.
Take the Fitkin elevator to the basement, and follow signs to the MRI Center.

Description: MRI involves a powerful but harmless magnetic field and radiowaves like the kind that transmit FM music. By looking for abnormalities in structure, the epilepsy team can determine whether there may be seizure producing areas in or adjacent to the regions of structural change.

Patient Instructions:

• You cannot have any metal in your body, including braces. You will be asked to complete a Safety Questionnaire prior to the MRI. Please call:
  
  

  203-688-5739
  203-688-4270

• Allow 2 hours for the procedure.
• You will hear a loud knocking noise while the scanner is in operation.
• Pediatric patients that require sedation to assist in the performance of the scan cannot eat for 6 hours prior to the scan. They can only drink apple juice or water up to 2 hours prior to the scan.

Faculty in our program participate in several research studies using advanced neuroimaging methods such as functional MRI (fMRI), magnetic resonance spectroscopy (MRS), spike triggered fMRI and research positron emission tomography. These procedures are performed in collaboration with colleagues in the magnetic resonance research center that is in the new Anlyan Center for Medical Research & Education.

Positron Emission Tomography (PET scan)

20 York Street, New Haven, CT.
Go to the East Pavilion. Take the elevator to the 2nd floor and sign in at the Diagnostic Imaging Admission desk.

Description: A PET scan allows the physicians to observe the changes in brain metabolism and chemistry. The PET scan uses radioactive isotopes to outline the size, shape, and location of organs. It is used in the brain to provide a measure of organ function.

Patient Instructions:

• Do not eat or drink for 6 hours prior to exam.
• The test is not painful; however there will be an IV inserted which may cause some discomfort.
• You will be injected with the radioactive isotope and then wait 1 hour.
• The scan itself is approximately 8 minutes long.
• If you have had a CT scan, the experience of being "inside" the PET scan is similar.
• Allow 2 hours for the total procedure.
• Adult safety & use information
• Child safety & use information

Single Photon Emission Computed Tomography (SPECT):

20 York Street, New Haven, CT.
Go to the East Pavilion. Take the elevator to the 2nd floor and sign in at the Diagnostic Imaging Admission desk.

Description: SPECT is a nuclear medicine procedure which uses a radioactive compound to create images of the cerebral blood flow. The test has specific use in epilepsy because decreased cerebral blood flow in a focal area is a marker of the interictal epileptogenic zone.

There are two ways of doing the SPECT, during a seizure (ictal) and between seizures (interictal). The ictal SPECT provides the opportunity to image cerebral blood flow during a seizure and identify focal areas of hyperperfusion for the purpose of localization.

The interictal SPECT scan is more likely to show a region of decreased blood flow in patients with frequent seizures.

Patient Instructions:

• The test is not painful; however there will be an IV inserted which may cause some discomfort.
• You will be injected with the radioactive isotope.
• Allow an hour and a half for this procedure.
• Adult safety & use information
• Child safety & use information

Outpatient Electroencephalogram (EEG)

789 Howard Avenue, New Haven, CT.
Enter the Dana Building and take elevator to the 2nd floor. Once you come off the elevator, follow around to the main corridor and take a right. You will see a sign for Neurophysiology Department.

Description: An electroencephalogram (EEG) is a safe and painless test that measures and records the electrical activity of your brain by using sensors (electrodes) attached to your head and connected by wires to a computer. The computer records your brain's electrical activity on the screen or on paper as wavy lines. Certain conditions, such as seizures, can be detected by observing changes in the normal pattern of the brain's electrical activity.

Patient Instructions:

• Tell your doctor if you are taking any medications. Certain medications (such as sedatives and tranquilizers, muscle relaxants, sleeping medications, or medications used to treat seizures) can affect your brain's usual electrical activity.
• Avoid foods that contain caffeine (such as coffee, tea, cola, and chocolate) for at least 8 hours before the test.
• Your hair should be clean and free of sprays, oils, creams, lotions, and other hair preparations. Shampoo your hair and rinse with clear water the evening before or the morning of the test. Do not apply any hair conditioners or oils after shampooing. Do not braid or tease the hair.
• Many small metal discs will be attached to the scalp with special paste.
• After the EEG the paste and electrodes will be removed by the technician. Small reddened areas may be noted on the scalp which will disappear in a short period of time.
• Allow an hour and a half for this procedure.
• Sometimes you will be asked to stay awake the night before, since it can enhance abnormalities.

Continuous Audio Visual EEG Recording (Phase I):

20 York Street, New Haven, CT.
Go to the first floor of the East Pavilion and sign in at the Admitting Desk.

Description: Continuous Audio Visual EEG recording is a standard of care in establishing an accurate diagnosis in epilepsy. The technicians will attach about 25 electrodes to your scalp using a special adhesive. Each electrode is connected to a wire which eventually connects to a computer system. Your brain emits very weak electrical discharges which the electrodes are able to collect. During various activities, such as a seizure, the electrodes over the active areas receive more electrical stimulation than the other electrodes. Your doctor is able to study this information to help determine the area in the brain responsible for the seizures. These electrodes will remain attached for the entire duration of the hospital stay. To help seizures occur naturally so they can be studied, we often will remove medications during this testing.

Sometimes we will try to perform an injection during the seizure for an ictal SPECT scan which can be done after you recover from your seizure. This helps to localize seizure generating areas of the brain, and shows blood flow changes with seizures.

In addition to EEG monitoring, you will be monitored on an audio-video camera. Your image, along with simultaneous EEG recordings, is saved. When you have a seizure, the doctor will be able to review the EEG and see exactly how you responded. This will help determine the location of the seizures, and their severity.

Patient Instructions:

• You will be admitted to the hospital for Continuous Audio Visual EEG recording.
• You will be admitted to a specialized room for monitoring.
• Medication, hormone, blood sugar levels and EKG may be monitored in addition to the EEG.
• You will see a variety of specialized personnel including doctors, neuro-psychologists, nurses, EEG technicians, and monitor watchers.
• Various seizure activation procedures, (i.e., medication reduction and sleep deprivation) may be used to assist in recording your seizures.
• Your seizures will be videotaped and reviewed by the epilepsy team to establish an accurate diagnosis and to formulate a plan of care, which may include medication or surgery.

Neuropsychological Testing

An important part of the overall care and treatment of patients includes Neuropsychological testing. The specifics of Neuropsychological testing are different for children and adults, but both share the common goal of helping doctors, patients, and their families understand how epilepsy may affect cognitive functions such as memory, language, and attention. Neuropsychological testing also includes an assessment of how epilepsy and related issues can affect a person's emotional function.

Neuropsychological Testing in Children

The Neuropsychological evaluation of a child with epilepsy can help us to understand how seizures influence brain development from a functional point of view. While the other tests (EEG and imaging) can help understand the underlying neurological cause and pinpoint the origin of the seizures, they do not provide information about how seizures affect a child's behavior and learning abilities. Neuropsychological testing can provide this information and assist the Physician team in managing the seizures (for example, helping to localize seizures, understand side effects of medication, and help establish risk-benefit profiles of treatment options). The testing can also be an important tool to help school personnel understand how seizures affect learning in unique ways that differ from other types of learning problems such as dyslexia or ADHD.

What does the neuropsychological evaluation consist of?

The neuropsychological evaluation typically includes administration of standardized tests to determine a child's level of ability in the following areas:

• General intellectual function (IQ testing)
• Visual perception and nonverbal information processing
• Speech and language development
• Attention
• Processing speed
• Learning and memory
• Executive function (skills such as planning, organization, self-monitoring, ability to shift thinking patterns flexibly, and inhibition)
• Screening of achievement (reading, spelling, math)
• Screening of motor skills (sensorimotor integration and manual dexterity)
• Behavioral and emotional development

The typical battery includes direct, face-to-face testing time of about 4 hours for most children, although this can vary depending on a child's age and skill level. After the evaluation is completed, a written summary and interpretation of the results is prepared for the treatment team and the results shared with the parents. If the results indicate the presence of any type of learning problems, the results can also be shared with the school team assigned to working with that child.

The Adult Neuropsychological Examination

The majority of individuals with epilepsy do not have significant problems with functioning in everyday life. However, there are some instances where seizures can greatly affect function, particularly when seizures are hard to control with medications. The Neuropsychological examination of adult patients can help to identify areas of difficulty in cognitive function that are related to the parts of the brain involved in seizure onset, medication effects, and emotional/psychological issues that may come up.

Neuropsychological testing can be done in an outpatient setting, or may be performed during a hospital admission for a comprehensive diagnostic evaluation that also includes EEG-Video monitoring and imaging studies. The adult neuropsychological testing takes approximately 5-6 hours but can vary depending on individual factors such as fatigue, prior testing experience, and the types of difficulty a patient may have with their cognitive abilities. The domains that are tested include:

• General intellectual function (IQ testing)
• Visual perception and nonverbal information processing
• Speech and language development
• Attention
• Processing speed
• Learning and memory
• Executive function (skills such as planning, organization, self-monitoring, ability to shift thinking patterns flexibly, and inhibition)
• Screening of achievement (reading, spelling, math)
• Screening of motor skills (sensorimotor integration and manual dexterity)
• Psychological function (emotional and personality disorders)

If a patient is considering surgery to treat their seizures, the results of the neuropsychological testing are presented in a multidisciplinary conference to the treatment team, who will incorporate the results of the testing into their overall assessment. The neuropsychological testing can specifically add to the localization of seizure onset, and to help determine if there are any risks of further cognitive impairment that might be associated with epilepsy surgery.