Epilepsy Evaluation & Presurgical Testing
Our goal is to collect the most complete data so we can suggest the best treatment options. Our specialists use advanced imaging technology in diagnosis and pre-surgical planning to pinpoint areas of the brain where seizures derive.
Electroencephalogram (EEG)
This allows us to monitor activity in the brain. It can be done in several ways:
- Ambulatory testing: This method involves a portable device that you take home and wear for 24, 48, or 72 hours.
- Video EEG monitoring: Performed at our Epilepsy Monitoring Unit (EMU) at Hartford Hospital, this is a three- to six-day inpatient visit to record your seizures.
- Intracranial EEG monitoring: To more accurately locate the portions of your brain involved in seizures, we may suggest surgery to place recording electrodes inside the skull. Think of scalp EEG as identifying the city, and intracranial EEG as identifying the street address. Neurosurgeon Brendan Killory, MD, performs this safe, diagnostic procedure during an inpatient hospital stay at Hartford Hospital.
Imaging
- 3T magnetic resonance imaging (MRI): This high-resolution, outpatient MRI looks for any abnormalities in the brain's shape or brain injuries that may cause seizures.
- Functional MRI (fMRI): This outpatient test measures brain activity by detecting changes in blood flow, helping to determine which parts of your brain are involved in activities like language and memory. It helps determine the safety of particular surgeries for you.
- Positron emission tomography (PET): This outpatient imaging test identifies areas of the brain where seizures start, using a very low amount of short-lasting radiation.
- Single photo emission computed tomography (SPECT): Requiring an inpatient stay at Hartford Hospital, the test can take about five days, showing blood flow in the brain during and between seizures. We inject a small amount of radioactive dye into your bloodstream the moment a seizure occurs to show the part of the brain that is most active during the seizure.
Functional Brain Mapping
- Cortical mapping: Once intracranial electrodes are implanted in or on the brain, we can use them to “map” or test functions in areas of the brain through small electrical impulses. This can help determine which areas of your brain perform critical functions such as language, movement, and seeing so we can avoid harming them during surgery.
Other
- Neurocognitive evaluation: This outpatient neuropsychology visit takes a few hours for a full evaluation of the types of thinking we all do including learning, memory, language, spatial skills, attention, and problem-solving. Since areas of your brain involved in seizures may not be working as well as others, the normal functions of the seizure area may be affected. Seeing which particular types of thinking are strongest and weakest can help guide surgical planning and avoid problems surgery could cause.
- Psychological evaluation: Surgery is a big deal and there is a lot to think about. We explore your expectations and factors like your support system and coping skills that impact how you manage pre-surgical workup and surgery. This helps your epilepsy team best support you.
- Wada test: Important in determining the safety of surgeries for you, this test determines which side of your brain is most needed for critical functions like speech and memory. It is done in the operating room and involves placing a catheter in the artery in your hip. Most patients go home the same day.
- MEG (magnetoencephalography): For this test – which uses very sensitive magnets to determine where seizures may be starting in the brain – you must travel to a city with MEG facilities. If we suggest this, our team balances travel expenses and the need for the best information from the most knowledgeable MEG providers.