Patient Services - Adult Epilepsy

Adult Epilepsy Program

Diagnostic Services

The advent of modern instrumentation and techniques together with the mushrooming of research on the brain and how it functions in health and disease combine to create a world-class diagnostic program at UCLA. The pre-surgical evaluation is a multi-step process:

• Initial consultation: A neurologist from the epilepsy surgical team conducts an initial assessment at our outpatient clinic. The doctor may prescribe additional medications or recommend tests to evaluate for possible surgery.
• Phase I evaluation: Patients are admitted to a special telemetry unit on the neurosurgery ward, where the medical team monitors seizure activity 24 hours a day with video recording and non-invasive scalp electroencephalograph (EEG) electrodes until enough seizures are documented to characterize them fully. Phase I also includes magnetic resonance imaging (MRI) and positron emission tomography (PET) brain imaging tests, as well as tests of memory, perception and other cognitive functions. These tests help pinpoint the seizure focus by providing additional information about any brain abnormalities.
  

  	A nurse is on duty 24 hours a day watching the patients on the UCLA telemetry ward to alert when the patients have seizures that are recorded by videotape and EEG.

• Case presentation: All findings are presented to the epilepsy surgery team, a panel consisting of neurologists, neurosurgeons, electrophysiologists, radiologists, psychologists and our coordinating clinical nurse specialist. The team determines whether the patient is a candidate for surgery and whether further testing is required.
• Further outpatient tests: In cases where the data fails to clearly pinpoint the seizure focus, the team recommends further outpatient tests, some in collaboration with other hospitals. These imaging tests include magneto-encephalography (MEG), performed at the Scripps Clinic in San Diego, Calif., or UC San Diego; single photon emission computed tomography (SPECT), performed at Cedars Sinai Medical Center in Los Angeles; functional magnetic resonance imaging (MRI), performed at the UCLA Brain Mapping Center; and various MRI protocols including T1- and T2-wieghted inversion recovery, FLAIR, 3-D reconstruction, diffusion tensor imaging (DTI), and positron emission tomography (PET)-MRI fusion, all performed at UCLA.
• Phase II evaluation: Occasionally the medical team needs additional information to pinpoint the seizure focus. Phase II evaluation involves surgery to place electrodes on the surface of the brain below the scalp (grid electrodes) or in deep structures in the brain (depth electrodes). The patient then remains on the telemetry ward for a second round of seizure monitoring. Stimulation brain mapping is performed if the suspected seizure focus is near a functional area of the brain, such as language or movement centers.
• Phase III: Phase III is the final phase at UCLA, where surgery is performed to control seizures. The results of the Phase I testing, the subsequent outpatient tests and/or the Phase II evaluation determines the recommended surgical plan. Additional tests may be performed in the operating room, including functional brain mapping of language or motor function, electrocorticography (ECoG), and intra operative image guidance.