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.
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 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.