Diagnostic and Phase I Testing

Evaluation takes place at 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 has a video camera with a microphone and special EEG equipment that records brain activity and changes in your behavior. Registered nurses, health care partners, and EEG Technologists monitor your seizures and make sure that you are as safe as possible when you have a seizure. We encourage a family member to stay in the room as often as possible.

What to expect during your stay

During EMU evaluation, you are limited to your hospital room. Patients may become bored while they are there. We suggest that you bring things to help pass the time such as puzzles, books, magazines, card games, and/or hand-held computer games. We provide a VHS videotape player/DVD player, but our supply of movies is limited. You may want to bring your own tapes. There is also a cabinet of games, toys, and puzzles for both children and adults.

When you are in the EMU, you may wear your own clothes, but all tops must have buttons down the front. We ask that you wash your hair before you come to the hospital. Do not use any gels, oils or conditioners on your hair.

Seizure recording

Shortly after coming to the unit, the EEG electrodes are put on your scalp. We then hook you to the video/EEG monitoring equipment and begin recording. The camera is on all the time and allows us to videotape your seizures. In some cases, lights may be left on at night in the room so the seizures can be recorded more clearly. The EEG is also running at all times.

Since our aim is to study your seizures, we may also have you stay awake all night (sleep-deprivation) to see if that causes a seizure. Maneuvers like hyperventilation and photic stimulation may be performed during your stay to provoke seizures. During your evaluation in the Epilepsy Monitoring Unit, we may drop or discontinue your epilepsy medication. When the epilepsy medicine is dropped, you may experience a grand mal seizure even if you do not normally have this type of seizure. Due to the fact that you may have harder seizures as a result of lowering your medicine, making you stay up all night, or trying to stress you, there is a possibility of injury (falls, cuts, broken bones, etc) from a seizure.

The Epilepsy Monitoring Unit evaluation with scalp EEG electrodes is helpful in diagnostic or phase I purposes.

Diagnostic evaluation

Diagnostic evaluation in the Epilepsy Monitoring Unit is carried out to characterize the type of spell: if it is epileptic (originating from the brain) or non-epileptic (from the heart, stress induced, or caused by other reasons).

It may also be performed to monitor the effect of epilepsy medication on seizure frequency. The evaluation may take 3 days to 2 weeks. If you are prescribed epilepsy medications for some other reason (like migraines, depression, etc.), there may be changes in your dosage at the discretion of attending epileptologist or your referring physician.

Phase I evaluation

In the patients who have epilepsy, phase I Testing is performed to find out where the seizures start in the brain. During Phase I, you will be hospitalized for approximately 7-10 days (the duration may be shorter, or possibly up to 2 weeks) so that we can record several of your seizures. How long you stay depends on how many seizures you have and how much information we obtained from those recorded seizures.

Interictal and Ictal SPECT scan

SPECT (single photon emission computed tomography) is a test that is done in the Department of Nuclear Medicine. This scan allows doctors to see how the blood is flowing through your brain after injecting a drug, called Neurolite, into your arm through a special tube in your vein. During phase I evaluation, at the earliest sign of seizure, Neurolite is injected by an EEG technologist as quickly as possible. This allows the area of the brain that draws more blood flow to be seen by the SPECT camera. The Ictal SPECT image is then obtained in the nuclear medicine lab within the next 1 to 3 hours. An Interictal SPECT scan is usually scheduled on an outpatient basis after discharge.

Before it is decided whether or not you are a surgery candidate, we need to learn more about your brain and how it works. More tests help us decide what type of treatment would be best for you. The following tests are usually done on outpatient basis for further evaluation.

Intracarotid amobarbital procedure (IAP) or Wada test

This test tells us where your memory or language is in your brain, how well it is working, and how speech or memory may be affected by the surgery. If we do surgery, we want to know what effect, if any, it may have on these areas. This test is done as an important study after Phase I admission is completed.

If you have an allergy to dyes or seafood, it is vital that you tell the nurse or physician. You will require special medicine before this test.

The doctors must do a special test called an "angiogram" before the Wada test. During this test, you will lie on a table with your head held still. The doctor will insert a thin flexible tube (called a "catheter") through an area at the top of your thigh. They will shave the hair in the groin area first. The doctor will thread the tube through your blood vessels to the carotid artery in your neck. Once the tube is positioned; the doctor will inject a small amount of x-ray dye into it to look at the blood vessels. When they inject the dye, you may feel a hot flushed sensation. This stops in a few seconds.

After the tube is positioned, the doctor will inject a medicine called sodium amytal through the tube. This will put one side of the brain to sleep and will make you weak on one side and/or may stop your ability to talk (this usually lasts 5-10 minutes). They will ask you to name and remember some words, colors and objects. This may be hard to do because part of your brain is asleep. The effects of the medicine will only last a few minutes. After about an hour, the doctor will do the same test for the other side of your brain.

Children may or may not have this test depending on how well they can cooperate.

After the Wada test, you will go to the recovery area for a short time. Then we will take you to the short stay unit on a hospital floor. In the short stay unit, you will get lunch and be able to watch television if you wish. They will be checking your thigh area to be sure it isn't bleeding. Most patients go home that evening, but some must spend the night in the hospital.

Visual Field Testing

The Visual Field Test is an eye test that measures how much you can see out of the sides of your eyes (peripheral fields). It is performed by an ophthalmology technologist. The test lasts about 45 minutes. Pediatric patients may or may not have this test.

PET/CT study

A PET (Positron Emission Tomography) / CT study is a special test used with a CT scanner to try to find an area of your brain that isn't working correctly. The part of your brain that isn't functioning very well may show up on this study after you get a special injection. This abnormal area may match where seizures are coming from. Some patients may get just a SPECT scan, a PET scan or both.

Epilepsy surgery conference

After all of these tests, members of the epilepsy surgery program including neurologists, neurosurgeons, neuroradiologists, neuropsychologists, speech therapists and a psychologist will meet to review your test results and discuss the best treatment for you.

Clinical visit

After the Epilepsy Surgery Conference, you may be contacted by your neurologist by phone or return to the clinic to discuss the test results and recommendations about treatment options for you.

The team will recommend one of several treatment options. The three most common options are:

1. You may have the brain surgery without any more tests
2. You may need more testing (called Phase II) to locate the spot where seizures start, or map out if the area to be removed could leave you with new problems
3. You may not be a good candidate for the surgery

If you are a surgical candidate, we will explain the surgery to you. The benefits and risks of surgery will be explained. You and your family play an important and active role in this decision-making process. You will have plenty of time to ask questions during this discussion and afterward.