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If we think you should be evaluated for possible surgery to help control your seizures, we bring you into the hospital for another EMU evaluation with additional tests. Ultimately, we need to capture 3-5 seizures to ensure all of your seizures are coming from one focus. In addition, we conduct an ictal SPECT study during this admission.

SPECT is a special type of brain scan. SPECT stands for Single Photon Emission Computed Tomography. A small amount of a radioactive isotope is given intravenously when the seizure occurs. This isotope goes to the part of the brain where the seizure is occurring. We often obtain inter-ictal SPECT for the baseline. This is a very safe test. This type of radioactivity only lasts a couple of hours in the body before it is eliminated. There are no special precautions after the injection.

High resolution MRI is performed to evaluate any structural abnormalities or lesions, which may be responsible for seizure foci.

This special brain scan is similar to the SPECT scan. PET stands for Positron Emission Tomography. It is also very safe and usually conducted as an outpatient study. The scan reveals any functional abnormality in the brain.

Neuropsychological tests show us how the different areas of the brain work. A neuropsychologist performs the tests in the office. The tests include thinking, problem solving, reading, visual identification, naming, other language function, memory, and movement. Testing helps identify areas where the patients may have problems, which are usually the areas where your seizures are happening. These tests may take several hours to complete so plan on getting a good night’s sleep and having a meal before coming.

Having epilepsy may cause many emotional problems for you and your family. In addition, many of anti-epileptic medications may cause emotional problems, such as depression and suicidal thought. Epilepsy surgery may result in many changes in your life. For this reason, a psychiatrist conducts an evaluation to assess the patient’s emotional readiness for epilepsy surgery and how much support they will receive after the procedure.

The WADA test is named after Dr. Juhn Wada. The test is conducted while the patient is awake. A barbiturate or other anesthetic medication is introduced into one of the internal carotid arteries via angiogram. The drug is injected into one hemisphere at a time in order to shut down temporarily any language and/or memory function in that hemisphere. The patient is engaged in a series of language and memory-related tests to understand which hemisphere support these functions.

This specialized MRI helps to understand how the different areas of your brain work. It measures the hemodynamic response (change in blood flow) related to neural activity in the brain with various activities.

Magnetoencephalogram (MEG) is a record of magnetic fields, measured outside the head, produced by electrical activity within the brain. The magnetic fields are produced by the same underlying electrical changes that give rise to the electroencephalogram (EEG). This technique is also used for mapping brain activity.

Once the patient completes all of the tests, our team meets to discuss the results. Team members include neurologists, neurosurgeons, nurses, neuro-psychologists, psychiatrists, neuro-radiologists, social workers or case managers, and EEG technologists. Together we review all of the information gathered and decide on the best treatment options. We later discuss this information with the patient and their family.

If the patient is thought to have potential benefit from the surgery based on previous tests, the next step is the actual epilepsy surgery. Our team approves epilepsy surgery only after a long and thorough evaluation process. We are careful since we want to offer patients the best possible chance for controlling the seizures, and be confident that we can perform the operation safely. The chance for a good result depends on many factors, and the evaluation process allows us to tell our patients how likely it is that they will have a good outcome.

Surgery is not the end of the process. The patient’s recovery period is also an important time. We keep all of our patients on anti-epileptic medications for at least one to two years. We can never be sure that we have removed all of the brain tissue that can cause seizures; however, the medications usually control the seizures. The medications also help protect the brain as it heals. The medications also help protect the brain as it heals.

Many people never have another seizure after their operation. Some people have a few seizures immediately after the operation and then gain full control. Others will have fewer or less severe seizures, and a few people will see no improvement. There are no guarantees for this operation, but we strive to give our patients the best chance possible. Whatever the outcome, we will continue to provide comprehensive care for our patients.