Diagnosis of seizure To detect brain abnormalities

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To detect brain abnormalities and identify the origin of seizure (epileptogenic lesion), tests may include:
  • Electroencephalogram (EEG). It is the most common test used to diagnose epilepsy. During the test, electrodes are attached to the scalp with a paste-like substance or cap for 20-30 minutes. The electrodes record the electrical activity of the brain and identify seizure focus which is the site in the brain from which the seizure originated with abnormal electrical impulses.
  • Video EEG Monitoring (VEM). EEG-video monitoring refers to continuous EEG recorded for a more or less prolonged period with simultaneous video recording during the clinical manifestations of seizure while patient is hospitalized. Having a correlation of the recorded patient’s behavior as video and the EEG activity, the site that originates seizure can be pinpointed more precisely, compared to EEG.
  • Magnetic resonance imaging (MRI). By using powerful magnets and radio waves to create detailed images of the brain, MRI is used to detect lesions or abnormalities in the brain that could be particular causes of seizure such as small brain tumor, congenital brain tumor and scar tissue.
  • Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of the brain are working. fMRI is usually used before surgery to identify the exact locations of critical functions such as movement and speech. Therefore neurosurgeons can avoid injuring those areas while operating.
  • Interictal SPECT (Single-photon emission computerized tomography). This test is used primarily if MRI and EEG failed to pinpoint the location of seizure. It is normally used to identify seizure focus when the patient is seizure-free for at least 24 hours.
  • Ictal SPECT (Single-photon emission computerized tomography). It is used to pinpoint seizure focus while patient is undergone 24-hour video EEG monitoring. This test uses a small amount of low-dose radioactive material to inject into a vein to create a detailed map of the blood flow activity in the brain during seizures.The radioactive substance will be trapped in the position of seizures.
  • Interictal PET (Positron emission tomography). PET scans use a small amount of low-dose radioactive substance injected into a vein to visualize active areas of the brain and detect abnormalities. It is normally used when patients do not have symptoms of seizure and EEG is required prior to having PET scan.
  • Functional mapping. This test is usually performed in patients with implanted electrodes. It is a painless procedure. After a sufficient number of seizures are recorded, brief electrical stimulation is provided through each electrode separately to determine the normal function of the part of the brain underneath the electrode. The purpose of this test is to map out critically important areas of the brain such as motor, sensory and language functions and to determine if there is any overlap with the seizure-generating regions. This allows neurosurgeons to minimize the risk of major neurological deficits and complications after surgery.
  • Neuropsychological tests and Wada test. Neuropsychological tests involve the assessment of thinking, memory and speech skills by using psychological tools. The test results helps to determine which areas of the brain are affected. Wada test is independent testing of language and memory function. This test is also used to predict post-operative deficits in language and memory function.
  • Continuous EEG monitoring in ICU. Continuous electroencephalogram monitoring is increasingly being used for brain monitoring in neurocritical care setting. Recent clinical researches reveal that critical patients with impaired consciousness and abnormal brain electrical activity are prone to develop seizure up to 40%. The damage of the brain results in serious complications such as long-term disability. However, patients might not manifest tonic-clonic seizure, continuous EEG monitoring is used as a standard practice. Following US guidelines, consensus statement of continuous EEG in patients with altered level of consciousness includes:
    • If alteration of consciousness is less than 24 hours, continuous EEG monitoring must be provided 48-72 hours.
    • If alteration of consciousness is more than 48 hours, continuous EEG monitoring must be provided at least 3-5 days.

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