Epilepsy Talk

Beyond EEGs…Diagnostic Tools for Epilepsy | September 13, 2010


How many of us have heard: “Your EEG is normal. You’re fine..” (“It’s all in your head?”)

I know of people who have had 5 EEGs, only to be properly diagnosed when they finally had Video EEG Monitoring. So if someone is trying to pass you off or is ignoring your symptoms, perhaps you should become a little more familiar with your diagnostic options…

EEG (Electroencephalogram) – is a non-invasive test which detects and records electrical impulses on the surface of the brain. These impulses are transmitted from small metal discs, placed on the person’s scalp, through wires which are connected to an electroencephalograph. This instrument is used to register the activity and record it on graph paper or on a computer screen. It is a safe and painless procedure which will not affect you in any way. An EEG is used by a neurologist to determine whether there are any irregular electrical activities occurring in the brain which may produce seizures. It can help identify the location, severity, and type of seizure disorder. An abnormal EEG does not diagnose epilepsy nor does a normal EEG reading exclude it.

Video EEG Monitoring – allows prolonged simultaneous recording of the patient’s behavior and the EEG. Seeing EEG and video data at the same time, permits precise correlation between seizure activity in the brain and the patient’s behavior during seizures. Video-EEG can be vital in the diagnosis of epilepsy and epileptic seizures. It allows the doctor to determine: Whether events with unusual features are epileptic seizures, the type of epileptic seizure, and the region of the brain from which the seizures arise.

Continuous Video EEG Monitoring – studies the brain waves over time. This can be accomplished through continuous Video EEG Monitoring, where a patient stays in a special unit for at least 24 hours. Antiepileptic medication is stopped for the duration of this test, since the objective is for seizures to occur so the abnormal brain waves they produce can be recorded.

A video camera connected to the EEG provides constant monitoring, enabling the medical team to pinpoint the area where a seizure occurs and track the patient’s physiological response to the seizure. Continuous monitoring can also help distinguish between epilepsy and other conditions. It can characterize the seizure type for more precise medication adjustments and locate the originating area of seizures within the brain, prior to surgery.

AEEG (Ambulatory Electroencephalography) – is a relatively recent technology that allows a prolonged EEG recording in the home setting. Its ability to record continuously for up to 72 hours increases the recording of an ictal event or interictal discharges. An AEEG is a less expensive alternative to in-patient monitoring, with costs that are 51-65 percent lower than a 24 hour inpatient admission for Video-EEG monitoring.

CAT Scan (Computerized Axial Tomography) or CT (Computed Tomography) – is an imaging technique that is a safe and non-invasive, using low radiation X-rays to create a computer-generated, three-dimensional image of the brain. It provides detailed information about the structure of the brain by using a series of X-ray beams passing through the head to create cross-sectional images of the brain. These may reveal abnormalities (blood clots, cysts, tumors, scar tissue, etc.) in the skull or brain which may be related to seizures. It allows physicians to examine the brain, section by section, as the test is being conducted. The CAT scan helps to point to where a person’s seizures originate.

MRI (Magnetic Resonance Imaging) – is a safe and non-invasive scanning technique that uses a magnetic field, radio waves and a computer to produce two or three-dimensional images of the brain. This detailed picture of brain structures helps physicians locate possible causes of seizures and identify areas that may generate seizures. No X-rays or radioactive materials are used, therefore this procedure is not known to be harmful. An MRI offers doctors the best chance of finding the source of seizures. Because seizures can arise from scar tissue in the brain, an MRI can show scar tissue and allow doctors to determine the nature of it. The images produced from the MRI are extremely precise. The information provided by MRI is valuable in the diagnosis and treatment of individuals with epilepsy and in determining whether surgery would be beneficial.

Functional MRI  takes images in “real-time” sequence and faster than the traditional MRI. By providing information about active brain tissue function and blood delivery, it is more precise and is often used before surgery to create a map of the brain and indicate where language, motor and sensory areas are located. During the scan, the patient is asked to perform certain tasks, such as tapping fingers or repeating a list of words. From the image, the neurological team can locate the exact seizure area of the brain.

MEG (Magnetoencephalography) – this technique has been available for several decades, but it is only recently that scanners involving the whole head have been available. The brain scan is based on natural magnetic fields. Detectors are placed on the skin near the head and then magnetic waves are used to measure brain activity. MEG is most often used to find the precise point in the brain where the seizures start by detecting the magnetic signals generated by neurons. With these signals, doctors can monitor brain activity at different points in the brain over time, revealing different brain functions. While MEG is similar in concept to EEG, it does not require electrodes and it can detect signals from deeper in the brain than an EEG.

Doctors also are experimenting with brain scans called MRS (Magnetic Resonance Spectroscopy) – that can detect abnormalities in the brain’s biochemical processes, and with Infrared Spectroscopy, a technique that can detect oxygen levels in brain tissue.

PET (Positron Emission Tomography) – is a scanning technique which detects chemical and physiological changes related to metabolism. It produces 3-dimensional images of blood flow, chemical reactions and muscular activity in the body as they occur. It measures the metabolism of glucose, oxygen or other substances in the brain, allowing the neurologist to study brain functions. By measuring areas of blood flow and metabolism, the PET scan is used to locate the site from which a seizure originates. A small amount of radioactive substance is injected into the body. When this substance reaches the brain, a computer uses the recorded signals to create images of specific brain functions. A functional image of brain activity is important because these changes are often present before structural changes occur in tissues. The information provided by the PET scan is valuable in both the diagnosis of seizure type and the evaluation of a potential candidate for surgery. PET images are capable of detecting pathological changes long before they would be made evident by other scanning techniques.

SPECT (Single Photon Emission Computed Tomography) is primarily used to view how blood flows through arteries and veins in the brain. Tests have shown that it might be more sensitive to brain injury than either MRI or CT scanning because it can detect reduced blood flow to injured sites. The test can track cerebral blood flow and detect alterations in brain metabolism between and during seizures. SPECT scanning is also useful for presurgical evaluation of medically uncontrolled seizures.

The Wada Test (Intracateroid Sodium Ambobarbital Test) – helps to identify the areas of a person’s brain that control speech and memory functions. During this pre-operative procedure, an angiogram of the brain is taken (an X-ray of the brain’s blood vessels). A drug is then injected into the patient that anesthetizes one side of the brain. The patient is asked to respond to a series of memory and speech-related tests. From this test, the neurosurgical team can determine where the areas of the brain that control speech and memory are located, and avoid those areas during surgery.

Blood Tests – often blood samples are taken for testing, particularly when a child is involved. These blood samples are screened for metabolic or genetic disorders that may be associated with the seizures. They also may be used to check for underlying problems such as infections, lead poisoning, anemia, and diabetes that may be causing or triggering the seizures.

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Resources:

http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm#152763109

http://www.netdoctor.co.uk/diseases/facts/epilepsy.htm

http://www.med.nyu.edu/cec/diagnosing/diagnostic/eeg_video_monitoring.html

http://www.everydayhealth.com/epilepsy/neuroimaging.aspx

http://www.nyuepilepsy.org/cec/diagnosing/diagnostic/meg.html

http://www.epilepsyyork.org/diagnosing%20epilepsy.htm

http://www.theuniversityhospital.com/epilepsy/html/diagnosisandtreatment/diagnostictests.htm

http://www.mayfieldclinic.com/PE-SPECT.htm


12 Comments »

  1. My EEGS are abnormal but they actually do not show the location of the true abnormality. The MRI shows the Periventricular Nodular Hetertopia. I have had 2 surgeries prior to the MRI and now they found the true abnormality. It was progress that showed the cause of the problem. It was no ones fault. It happened in the growth of a very few twisted cells that cause my seizures.

    Comment by Tonialpha — September 13, 2010 @ 3:06 AM

    • It’s too bad no one found it earlier, so you didn’t have to suffer through the surgeries. How long after the surgeries did they do the MRI and what will they do now about the twisted cells?

      Comment by Phylis Feiner Johnson — September 13, 2010 @ 8:16 PM

      • 10 years later is when the special MRI was done, approximately. It’s almost like a wink of an eye now.

        Comment by Toni Robison — April 30, 2012 @ 11:12 PM

  2. nice post. thanks.

    Comment by veterinary technician — October 5, 2010 @ 5:55 PM

  3. Almost regularly it seems I get EEGs done at my current neurologist. He has yet to tell me any results or any specifications in my brain…all he ever does it alter my dosages of medication or switch my meds (I’m pretty sure I’ve tried everything in the book). It was with my first neurologist that I first got diagnosed with epilepsy a little less than 10 years ago, after a CT scan in which she told me I had generalized seizures-they happen in all parts of my brain. I’m pretty sure I’ve gotten all of these tests done…including a sleep study. I got a VNS implanted a few years ago, which doesn’t work. My seizures continue-I have both grand mal (not as often as other seizures) and other seizures in which I become fixated and stare and my eyes widen and I smack my lips and fiddle with things (my family tells me this is what happens) I feel a brief aura before hand in which my heart rate speeds up and I get an extremelly scary deja-vu feeling, followed by a hallucination-type feeling. After the seizure, I recall that I had one and I have a bitter/metallic taste left in my mouth and a headache and I am tired. What I want to know is after all of these tests, how could it be that nobody knows the source of these? I also have a carnitine deficiency, adhd, anxiety disorder, and was once diagnosed with narcolepsy although I see no symptoms of that and don’t take meds. Is there a possibility that these horrifying attacks that happen are not seizures?

    Comment by Kelly — October 10, 2010 @ 2:21 AM

    • I’m so sorry for your disappointment. I have a 15 year old daughter with Epilepsy. She too has the same type of auras. She had a video EEG in September where they cold turkey’d her off her medicine. It took about 5 days but she had 3 grand mals in 4 hours. The video EEG helped them diagnose her epilepsy since MRIs are normal. They always start in her left arm, Then cross over to her right arm or leg, then within seconds she generalizes (grandmal). She has Right Parietal Lobe epilepsy with simple/partial secondary generalization. What a mouthful! Her seizures start in her Parietal lobe…only 5% of Epilepsy is Parietal lobe…The parietal lobe is responsible for sensory information…explains her auras! When she feels weird things in her hand…tingling, numbing that is a local seizure…then it starts jerking…she gets feelings of terror, then the seizure crosses over to her right leg…which starts shaking (partial) and then she generalizes (without meds).

      It sounds like you experience complex partials (unconscious stare, lip smacking, etc…). It sounds like you may also have Parietal Lobe epilepsy…because of your auras…they are very similar to my daughters auras. Hope you have found something out to help you.

      Comment by Nancy — October 7, 2011 @ 12:35 PM

  4. First of all, it’s your legal right to see all of your test results under the Freedom of Information Act.

    Second of all, I definitely think it’s time for a second opinion.

    I would do two things:

    1. Pick up your records from your current doc.
    2. Start a seizure diary, tracking your sleep patterns, what you eat, your activities, any emotional upsets, your auras (I get that nasty metallic taste in my mouth, too), how you feel before a seizure, during and after + the duration of the seizure.

    There’s a Comprehensive List of GOOD Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors under Top Posts on the home page. The list is based on eforum members own positive personal experiences with docs.

    Also, look at the post “Three Secrets to Better Care from Your Doctor” to help guide you to a more pro-active and helpful visit. Sadly, we have to be our own advocates. But it’s good to have someone with you at your doc visit to take notes, voice any observations that you were unaware of and be a “second pair of ears.”

    You definitely deserve better care than what you are getting.

    Comment by Phylis Feiner Johnson — October 10, 2010 @ 3:36 AM

  5. I had seizures when i was little, and ended up outgrowing them by 15. now my son has a seizure disorder and is taking medication in order to control the seizures. I had absent seizures, so i would have blackout spells that would range from seconds to up to 5 minutes. they continued to make me stare, and i would often find myself on the floor, or like one time, falling down some stairs.

    Comment by Katherine Palmer — March 27, 2011 @ 8:03 PM

    • Sounds like me when I was an adolescent. :-(

      When did your son develop HIS seizure disorder? (Around puberty?)

      What kind of seizures is he having and how has he been tested?

      Comment by Phylis Feiner Johnson — March 27, 2011 @ 10:06 PM

  6. Hi my son has epilepsy (grand Mal) he’s 2.5yrs old and started just before he was1year. We’ve had EEG, CAT scan, MRI and we are told ‘all clear’, so goodbye pretty much. He still has epilepsy and is on meds, I struggle to see why the investigation stops here, or why he needs to still be on the clobozam, can u shed some light on this for me?

    Comment by Nicola — August 19, 2014 @ 4:26 AM

  7. I for sure am not a doc. And I don’t know the answers. (Sorry.)

    But there are pediatric docs and special hospitals that are more finely attuned to your dilemma. (By the way, you’re not alone.)

    I don’t know where you live, but here are some docs that have been recommended by e-forum memebers based upon their own posive personal experiences.

    ARIZONA
    Dr. Kevin Chapman, Barrows Neurological Institute, Phoenix, AZ — Pediatric Epileptologist & Neurologist
    Dr. Randa Jarrar, Phoenix Children’s Hospital, Phoenix, AZ
    CALIFORNIA
    Dr. Kelfer, Cook’s County Children’s Medical Hospital, Los Angles, CA
    Dr. Nutik, Kaiser, Redwood City, CA
    Dr. Donald Shields, UCLA Mattel Children’s Hospital Division of Pediatric Neurology, CA
    Dr. Diane Stein, Irvine, CA
    Dr. Joyce Wu, UCLA Mattel Children’s Hospital Division of Pediatric Neurology, CA
    Dr. Mary Zupanc, Children’s Hospital, Orange County, CA — Epileptologist
    CONNETICUT
    Francine Testa, Yale-New Haven Hospital, New Haven, CT
    Susan Levy, Yale-NewHavenHospital, New Haven, CT
    Dr. Laura Ment, Yale-NewHavenHospital, New Haven, CT
    FLORIDA
    Dr. Ronald Davis, Orlando, FL
    Dr. Kojik, Orlando, FL
    Dr. Naqvi, Miami Children’s Hospital, Miami, FL
    Dr. Passero, St. Petersberg, FL
    GEORGIA
    Dr. Robert Flamini, Scottish Rite Children’s Hospital, Atlanta, GA
    Dr. Sandra Helmers, Emory University, Atlanta, GA
    Dr. Roger Hudgins, Scottish Rite Children’s Hospital, Atlanta, GA
    ILLINOIS
    Dr. Kelfer, Cook Children’s Medical Hospital, Cook County, IL
    Dr. Marianne Larsen, Children’s Memorial Hospital, Chicago, IL
    Dr. Douglas Nordli, Children’s Memorial Hospital, Chicago, IL — Pediatric Epileptologist
    Dr. Marvin A. Rossi, Rush University Medical Center, Chicago, IL
    Dr. Blas Zelaya, Peoria, IL
    INDIANA
    Dr. Vicenta Salanova, Riley Hospital for Children, Indianapolis, IN
    KENTUCKY
    Dr. Vinary Puri, Director of Child Neurology, Kosair Children’s Hospital and University of Louisville, Louisville, KY
    MARYLAND
    Dr. Eric Kossof, Johns Hopkins, Baltimore, MD
    Dr. William R Leahy, Greenbelt, MD
    Dr. Naidu, Kennedy Krieger Institute, Baltimore, MD
    MASSACHUSETTS
    Dr. Adjani, UMassachusetts Medical Center, MA
    Dr. Blaise Bourgeois, Children’s Hospital, Boston, MA
    Dr. Laurie Douglass, Boston, MA
    Dr. Frances E. Jensen, Children’s Hospital, Boston, MA
    Dr. Joseph Madsen, Children’s Hospital, Boston, MA
    Dr. Annapurna (Ann) Poduri, at Boston Children’s Hospital, Boston, MA
    Dr. Kenneth Sassower, Massachusetts General Hospital, Boston, MA — Children & Adults — Neurologist/Epileptologist
    Dr. Ronald Thibert, Massachusetts General Hospital, Boston, MA
    Dr. Elizabeth Thiele, Massachusetts General Hospital, Boston, MA — Pediatric Neurologist/Epileptologist
    MICHIGAN
    Dr. Harry Chugani, Detroit Children’s Hospital, Detroit, MI
    Dr. Eileen McCormick, Michigan Institute for Neurological Disorders (MIND), Farmington Hills, MI
    MINNESOTA
    Dr. Jason Doescher, Minnesota Epilepsy Group, St. Paul, MN
    Dr. Mary Dunn, St. Paul Children’s, St. Paul, MN
    Dr. Frost, Minnesota Epilepsy Center, St. Paul, MN
    MISSOURI
    Dr. David Callahan, St. Luke’s Hospital, Chesterfield, MO
    Dr. James Rohrbaugh, St Luke’s Hospital, Chesterfield, MO
    Dr. William Rosenfeld, Children’s Hospital, St. Louis, MO
    Dr. Micheal Symth, St. Louis Children’s Hospital, St. Louis, MO — Neurosurgeon
    Dr. Richard Torkelson, Children’s Mercy, Kansas City, MO
    Dr. Edwin Trevathan, St. Louis Children’s Hospital, St. Louis, MO
    Dr. John Zempel, St. Louis Children’s Hosptial, St. Louis, MO — Epileptologist
    NEW JERSEY
    Dr. Daniel Alder, New Jersey
    Dr. Steven Kugler, Robert Wood Johnson Hospital, New Brunswick, NJ
    Dr. Wollack, Robert Wood Johnson Hospital, New Brunswick, NJ
    NEW YORK
    Dr. Claudia Chiriboga, Columbia Presbyterian, New York City, NY
    William S. MacAllister, Ph.D., Pediatric Neuropsychologist, NYU Comprehensive Epilepsy Center, New York City, NY
    Dr. Gail Solomon, NYU Comprehensive Epilepsy Center, New York City, NY
    NORTH CAROLINA
    Dr. Corbier, Concord, NC
    Dr. Darrell V. Lewis, Duke Children’s, Atlanta, NC
    Dr. Gallentine, Duke Children’s, Atlanta, NC
    Dr. Michael B. Tennison, Chapel Hill, NC
    Dr. Shana Wallace, Charlotte, NC
    OHIO
    Dr. Kerry Crone, Children’s Hospital Medical Center, Cincinnati, OH
    Dr. Cynthia Foldvary, Cleveland Clinic, Cleveland, OH
    Dr. David Franz, Children’s Hospital Medical Center, Cincinnati & Mason, OH
    Dr. Gupta, Cleveland Clinic, Cleveland, OH
    Dr. Roger Hudgins, Akron Children’s Hospital, Akron, OH
    Dr. Kotogal, Cleveland Clinic, Cleveland, OH – Epileptologist
    Dr. Lichwanni, Cleveland Clinic, Cleveland, OH — Epileptologist
    Dr. Ingrid Tuxhorn, Rainbow’s Babies and Children’s Hospital, Cleveland, OH
    Dr. Wyllie, Cleveland Clinic, Cleveland, OH — Epileptologist
    PENNSYLVANIA
    Dr. Khurana, St. Christopher’s Hospital, Philadelphia, PA
    Dr. Roger Porter, Children’s Hospital of Philadelphia, Philadelphia, PA
    Dr. Strom, Children’s Hospital of Philadelphia, Philadelphia, PA
    TENNESSEE
    Dr. Stephen Fulton, LeBonheur Children’s Hospital, Memphis, TN — Epileptologist
    Dr. Paul Knowles, T.C. Thompson’s Children’s Hospital, Chattanooga, TN
    Dr. Barbara Olsen, Pediatric Neurology Associates, Nashville, TN
    Dr. James Wheless, LeBonheur Children’s Hospital, Memphis, TN
    TEXAS
    Dr Gretchen Von Allmen, University of Texas Physicians/Memorial Hermann Hospital, Houston, TX
    Dr. Imad T. Jarjour, Houston, TX
    Dr. Howard Kelfer, Cook Children’s Medical Center, Fort Worth, TX
    Dr. Anthony Riela, Texas Child Neurology, Plano, TX
    Dr. Josh Rotenberg, Pediatric Neurologist, Texas Medical & Sleep Specialists, San Antonio and Houston, TX
    Dr. Angus Wilfong, Texas Children’s Hospital, Houston, TX
    VIRGINIA
    Dr. Pearl, Fairfax, Virginia
    WASHINGTON, D.C.
    Dr. Pearl, Children’s National Medical Center, Washington, D.C.
    WISCONSIN
    Dr. Kurt Hecox, Children’s Hospital of Wisconsin, Milwaukee, WI
    Dr. S. Anne Joseph, Children’s Hospital of Wisconsin, Milwaukee, WI
    Dr. Sean Lew, Children’s Hospital of Wisconsin, Milwaukee, WI
    Dr. Charles Marcuccilli, Milwaukee, WI — Epileptologist

    http://epilepsytalk.com/2014/08/06/2014-2015-comprehensive-list-of-good-neurologistsepileptologistsneurosurgeonsand-pediatric-doctors-3/

    There are also the 2014-2015 Top-Ranked Pediatric Hospitals for Neurology & Neurosurgery, compiled by the U.S. World & News Report — an impartial and prominent source of excellence in surveys and reporting.

    Surveyed were 183 pediatric centers in order to obtain clinical data in 10 specialties and 150 pediatric specialists in each specialty where they would send the sickest children.

    To find out more about these Pediatric Neurology and Neurosurgery Hospitals click on: http://health.usnews.com/best-hospitals/pediatric-rankings

    I beg you to take these test records and get at least one or two more consults. Another pair of eyes may interpret something other docs may not have. They may want to proceed with their own tests. And they may want to consider your son as a candidate for surgery.

    The best of luck (and health) for both of you.

    Comment by Phylis Feiner Johnson — August 19, 2014 @ 8:52 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I've also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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