UCLA Campus    |   UCLA Health    |   School of Medicine Translate:
UCLA Health It Begins With U

Clinical Updates

Print
Email

Clinical Updates

 
Neurology

UCLA offers new neurophysiology tests to diagnose and treat epilepsy and cognitive disorders

03/07/2011

CU-Neuro Physiology TreatmentUCLA’s Clinical Neurophysiology Department has recently added two new cost-efficient and highly accurate tests that aid in the diagnosis and treatment planning of patients suffering from epilepsy or cognitive disorders that affect memory and attention. The new tests are dipole source localization, a state-of-the-art computer model that analyzes traditional EEG results to pinpoint the origin of seizures, and P300 evoked potentials, which uses a non-invasive device to measure cognitive speed, and help diagnose subtle forms of brain damage.

The department runs seven specialized laboratories that offer comprehensive testing to investigate and monitor the function of nerves, neurons, muscles and neural pathways.

Dipole source localization helps pinpoint seizure activity

Whether caused by epilepsy, tumors or infections, seizures occur when there is a sudden surge of electrical activity in the brain. People who suffer from medically intractable epilepsy — recurrent seizures that are not adequately controlled by medications — can undergo surgery to remove the epileptic area, the part of the brain causing the seizures. For the surgery to be effective, neurologists and neurosurgeons must be able to accurately locate the origin of seizure activity.

Dipole source localization provides computer analysis of standard EEG data to search for the source of seizures. The computer program takes into account the shape and size of the patient’s head, the patient’s age and the direction of the EEG epileptic spikes’ dipoles. Dipoles are the collections of neurons that discharge in an organized way during epileptic EEG activity. The process then performs statistical and mathematical analysis on the data before transposing the electrical activity onto a visual diagram of the patient’s brain. Studies show that the computer model is sufficiently accurate to offer a useful, low-cost alternative to magnetic encephalography (MEG). When used together with magnetic resonance imaging (MRI), positron emission tomography (PET), and video-EEG monitoring of epileptic seizures, these techniques can localize the epileptic region well enough for surgery in many patients. In other patients, the techniques help to determine where to place intracranial electrodes.

P300 cognitive evoked potential test

Using a new test that measures the speed with which patients process cognitive information, physicians are better able to diagnose the cause of memory loss and inattention. Patients with Alzheimer’s disease or dementia typically process cognitive information more slowly than healthy patients and those suffering from depression. UCLA’s new P300 cognitive evoked potential test is a painless and noninvasive way of measuring cognitive processing speeds for the diagnosis of serious cognitive disorders.

The test involves the use of a device that presents a patient with a cognitive task while an EEG measures electrical brain activity. In a typical test, a patient with electrodes placed on the scalp is presented with two tone patterns — a frequent low- pitched tone and an infrequent high-pitched one. The patient is asked to count the higher pitched tones or press a button every time the higher pitched tone sounds. Shortly before the patient presses the button or counts the high-pitched tone, the patient’s brain will register the thought “this is the tone I’m supposed to listen for!” That produces an extra brain wave that can be recorded and measured. A patient’s cognitive processing speed is the lag between the time the tone is presented and when that P300 brainwave happens. In patients with cognitive disorders like Alzheimer’s disease and dementia, the lag is measurably longer than it is for healthy patients or those suffering from depression, making the test a useful diagnostic tool.

Clinical Neurophysiology at UCLA

Leaders in the field since the 1950s, UCLA clinical neurophysiologist physicians diagnose, study, manage and provide intra-operative monitoring of epilepsy, dementia, Alzheimer’s disease and any other disorders or injuries that affect the nervous system. A pioneer in the development of many modern electro-encephalography (EEG) monitoring techniques, the UCLA program has innovated many brainwave monitoring services that are now widely used around the country and the world. UCLA’s Clinical Neurophysiology Program Project Grant is the NIH’s longest continuously funded neurology program and has been home to many advances in the understanding of epilepsy and its diagnosis and treatment.

Computer model a low-cost supple-ment to seizure localization testing

Studies show that computer analysis of standard EEG data can meaningfully contribute to locating the source of seizure activity, allowing some patients who would otherwise not be candidates to benefit from surgical treatment, according to Marc Nuwer, M.D., Ph.D., head of the Clinical Neurophysiology Department, and program director, Clinical Neurophysi-ology Training Program. The ability to pinpoint the source of seizures is key to developing effective treatment plans; dipole source localization can be helpful when other tests are unavailable or prove to be inconclusive.

“With accurate seizure source localization, about 70 percent of patients with epilepsy can be surgically cured and never have a seizure again,” Dr. Nuwer says. “Another 20 percent will have far fewer seizures than they had before surgery.”

Participating Physician Leadership

Marc Nuwer, M.D., Ph.D.
Department Head, Clinical Neurophysiology
Program Director, Clinical Neurophysiology Training Program

John Stern, M.D.
Director, Adult Epilepsy Service

Jerome Engel, Jr., M.D., Ph.D.
Director, Seizure Disorder Center

Joyce Wu, M.D.
Director, Pediatric Epilepsy Service

Perry Shieh, M.D., Ph.D.
Clinical Neurophysiology
Director, Neuromuscular Medicine Program

Pedro Coutin-Churchman, M.D., Ph.D.
Technical Manager,
Clinical Neurophysiology Laboratories

Contact Information
Clinical Neurophysiology Lab
300 UCLA Medical Plaza Suite 2100
Los Angeles, CA 90095
(310) 825-0177





Add a comment


Please note that we are unable to respond to medical questions through the comments feature below. For information about health care, or if you need help in choosing a UCLA physician, please contact UCLA Physician Referral Service (PRS) at 1-800-UCLA-MD1 (1-800-825-2631) and ask to speak with a referral nurse. Thank you!


comments powered by Disqus