Diagnostic and Phase I Testing

Evaluation takes place in a facility set up for 24-hour video and EEG monitoring. We have several Epilepsy Monitoring Units for this purpose, as well as special care units at Henry Ford Hospital and Henry Ford West Bloomfield Hospital. Each room includes a video camera, microphone and specialized EEG equipment to record brain activity and behavioral changes. Registered nurses, health care partners and EEG technologists monitor your seizures and help ensure your safety. We encourage a family member to stay with you as often as possible.

What to expect during your stay

During EMU evaluation, you will remain in your hospital room. To help pass the time, we recommend bringing items such as books, puzzles, magazines, card games or handheld devices. We provide a DVD player, but movie availability may be limited, so you may want to bring your own. A shared cabinet of games and activities is also available.

You may wear your own clothes, but all tops must button down the front. Please wash your hair before arrival and avoid using gels, oils or conditioners.

Seizure recording

Shortly after admission, EEG electrodes are placed on your scalp and connected to continuous video/EEG monitoring. Recording takes place at all times. In some cases, lights may remain on overnight to improve visibility.

To better understand your seizures, we may use techniques such as sleep deprivation, hyperventilation or photic stimulation. In some cases, your epilepsy medication may be reduced or temporarily stopped. This may increase the likelihood or severity of seizures, including the possibility of a generalized (grand mal) seizure. Because of this, there is a risk of injury such as falls or other trauma.

Epilepsy Monitoring Unit evaluation with scalp EEG electrodes is most commonly used for diagnostic or Phase I evaluation.

Diagnostic evaluation

Diagnostic evaluation helps determine whether your episodes are epileptic (originating in the brain) or non-epileptic (such as cardiac, stress-related or other causes).

This evaluation may also assess how well medications control seizure frequency. Testing typically lasts from three days to two weeks. Medication adjustments may be made based on your care team’s recommendations.

Phase I evaluation

For patients with epilepsy, Phase I testing identifies where seizures begin in the brain. This usually requires hospitalization for 7 to 10 days, though it may be shorter or extend up to two weeks depending on how many seizures are recorded and the information obtained.

Interictal and ictal SPECT scan

SPECT (single photon emission computed tomography) is performed in the Department of Nuclear Medicine to evaluate blood flow in the brain. During a seizure, a tracer is injected to highlight areas of increased activity. Imaging is completed within one to three hours. An additional interictal (between seizures) scan is typically scheduled after discharge.

Additional outpatient testing may be required to determine the most appropriate treatment plan.

Intracarotid amobarbital procedure (IAP) or Wada test

This test evaluates memory and language function to help determine how surgery may affect these abilities. It is typically performed after Phase I evaluation.

An angiogram is performed first, during which a catheter is inserted through the groin and guided to the carotid artery. A contrast dye is injected to visualize blood vessels. You may briefly feel a warm sensation.

A medication is then administered to temporarily affect one side of the brain. During this time, you will complete memory and language tasks. The process is repeated on the opposite side. Effects typically last only a few minutes.

After the procedure, you will recover briefly and may go home the same day or stay overnight if needed.

Visual field testing

This eye test measures your peripheral (side) vision and is performed by an ophthalmology technologist. The test typically takes about 45 minutes.

PET/CT study

A PET/CT scan helps identify areas of the brain that are not functioning normally. These areas may correspond to where seizures originate. Some patients may receive a PET scan, a SPECT scan or both.

Epilepsy surgery conference

After testing is complete, a multidisciplinary team of specialists reviews your results to determine the best treatment plan.

Clinical visit

After the conference, your neurologist will contact you or schedule a follow-up visit to discuss results and treatment recommendations.

The team may recommend one of the following:

1. Surgery without additional testing
2. Further evaluation (Phase II testing)
3. Non-surgical treatment options

If surgery is recommended, we will explain the benefits and risks in detail. You and your family play an important role in deciding the next steps, and you will have time to ask questions.