Diagnostic tests

1

MRI brain

This tests uses magnetic fields to produce images of your brain.

We aim for precisely delineating the focus with the help of post processing software to get detailed images and to understand if there are any abnormalities that were previously unseen.

2

Functional Magnetic Resonance Image (fMRI)

This is normally performed the same way as the standard MRI

However, you will be asked to perform a task, answer questions or look at the pictures during the scan.

3

Positron Emission Tomography (PET SCAN)

This uses a radioactive dye to highlight any abnormalities in the brain that are using less energy. This can be useful in localising the source of seizures.

4

Electroencephalogram (EEG)/ Video Telemetry

This is a painless, non-invasive procedure where electrodes are glued to your scalp using a special glue and sticky tape. These electrodes are then connected to the EEG machine which then captures and records the electrical activity in your brain. A video recording is also performed whilst you are having your this recording to match brain waves to the seizure activity.

This is normally a week long admission , and we aim to record three or more of your typical/ habitual seizures. Your epileptologist may discuss a reduction in your antiseizure drugs.

During the time you are connected to the EEG machine, you will be continuously monitored , there will e a skilled nurse to maintain your safety if you have a seizure.

We discuss about few diagnostic tests used in our unit to understand the nature of your epilepsy and find the epileptogenic focus in your brain

Once all needed tests are completed,

the results will be reviewed and discussed at a meeting where all professionals involved in your care would sit and discuss the further treatment and surgical strategy for you.

If surgical removal of the focus of epilepsy is an option, you would be referred to our neurosurgeon.

if resection is not possible for your epilepsy, other surgical options may include a vagal nerve stimulator, This involves placement of a small battery implanted under your left collar bone, with a lead running to the side of your neck underneath your skin up to the vagal nerve.

This generator sends impulses up your vagal nerve to your brain every couple of minutes, which interrupts the burst of electrical activity that causes a seizure.

This is not a curative measure, but can reduce the frequency and severity of your epilepsy.

Intracranial EEG

This may need to be completed if it was not possible to gain the necessary information for the EEG you had previously.

This involves a number of electrodes being implanted into your brain in the areas where seizure activity is suspected. The final number of electrodes will differ in each person, depending on the the suspected location and complexity of the case.

This will be normally a weeklong admission after the electrode insertion, however, may need extension if enough seizures cannot be recorded.

This test will involve electrode implantation in the operation theatre, that may need around six ours, after which, you will be connected to the monitoring equipment.

Our Epileptologist will discuss with you about the need for medication reduction, in order to plan for drug reduction.

Neuropsychiatry and Neuropsychology tests

Neuropsychiatry:

This is an assessment that is useful to see if your epilepsy has caused any other problems that you may not be aware of .

The Psychiatrist will be able to tell if surgery may help with these problems and if you will need any extra post operative follow up after the surgery.

During this assessment, you will be asked to discuss several aspects of your life, which may include your childhood, growing up, your relationships, working and any previous psychiatric history.

Neuropsychology:

This assessment will involve a variety of pen, paper and computerised tests to assess functions of different lobes of brain. These tests may include tests of concentration language, memory, visuospatial skills, planning and problem solving skills.

This assessment normally takes 3-4 hours to complete, depending on the particular needs of each person.

It will confirm the areas of strengths and weakness in your thinking and memory which can be found if certain areas of your brain are affected with seizures.

This test can also show if a part of your brain that we are contemplating a surgery to remove the seizure generating focus, is responsible for any functions that other parts of your brain cannot take over, and would be helpful in predicting any cognitive deficits post surgery.

CT- this scan is a kind of X ray that may show the structure of the brain and may help pick up anormality that can cause epilepsy

SPECT (Single photon emission computed tomography) SPECT

This test uses radioactive dye, that is injected at the onset of seizure to look at the blood flow in the brain

The blood flow increases in those areas of the brain most involved in a seizure. This test requires admission in a hospital.

WADA:

This test investigates what side of your brain controls language, and memory functions if other tests have been unclear. The procedure involves an intervention radiologist injecting an anaesthetic injection into a blood vessel in your leg. This anaesthetic will put the side of brain it's injected into to sleep for a short period, during which you will be asked questions, memorise pictures and to carry out simple tasks such as raising your arms by the neuro psychologist. This is a day case admission. You would be instructed to not eat/ drink anything from the night before the test. Our neurophysiologist will record your EEG and perform baseline test with neuropsychologist prior to the test. This test would be done in a cathlab.

Other Diagnostic tests

CT- this scan is a kind of X ray that may show the structure of the brain and may help pick up anormality that can cause epilepsy

SPECT (Single photon emission computed tomography) SPECT

This test uses radioactive dye, that is injected at the onset of seizure to look at the blood flow in the brain

The blood flow increases in those areas of the brain most involved in a seizure. This test requires admission in a hospital.

WADA:

This test investigates what side of your brain controls language, and memory functions if other tests have been unclear. The procedure involves an intervention radiologist injecting an anaesthetic injection into a blood vessel in your leg. This anaesthetic will put the side of brain it's injected into to sleep for a short period, during which you will be asked questions, memorise pictures and to carry out simple tasks such as raising your arms by the neuro psychologist. This is a day case admission. You would be instructed to not eat/ drink anything from the night before the test. Our neurophysiologist will record your EEG and perform baseline test with neuropsychologist prior to the test. This test would be done in a cathlab.