Advanced Diagnostic Testing and Monitoring
When you come to NewYork-Presbyterian, you benefit from a team approach that starts during your very first visit, when we begin assembling a plan of care. In addition to blood tests and magnetic resonance imaging (MRI) and computed tomography (CT) scanning, our specially trained physicians and neurophysiology technologists perform advanced electrodiagnostic testing to learn more about your seizures. You may have one or more of these tests:
- Electroencephalography (EEG or "brain wave test"), an examination of your spontaneous brain activity. We also offer outpatient EEG testing, enabling you to be mobile and go about your day while the testing is being performed over a period of up to 24 hours.
- Video-EEG monitoring, which we use to diagnose complex seizure disorders. The procedure requires you to stay in the hospital for four to five days in one of our epilepsy monitoring units. Data generated by this test improve diagnostic certainty and are very helpful in making treatment decisions, including the choice of the most effective antiseizure medication for you.
- Intracranial monitoring, if your doctor decides you may benefit from epilepsy surgery, but it is not clear exactly where in the brain your seizures are coming from. Intracranial monitoring may involve the placement of electrodes onto your brain through a larger operation (subdural monitoring) or placement of many electrodes into the brain through small (2 millimeter) holes in the skull (stereo-EEG monitoring), depending on the specifics of your epilepsy. "Stereo-EEG" has changed how we approach many people with complex epilepsy, making their evaluation safer and more accurate.
We also use neuropsychological testing to identify your areas of strength and weakness in language, memory, concentration, and other cognitive functions.
Customized Treatment for Your Seizures
With the information we gather during your evaluation, our epileptologists (doctors with special training in epilepsy care), neurologists, neurosurgeons, neurophysiologists, and neuroradiologists work together to customize your treatment. They collaborate with a team of nurses, social workers, neuropsychologists, language therapists, and occupational and physical therapists to provide the best care for you. Your treatment may include:
- Antiseizure medications are effective in about two-thirds of people with epilepsy. We'll try a variety of medications to see if we can find one that works well for you.
- You may be eligible to participate in a clinical trial of a new epilepsy treatment. Our researchers played a significant role in the development and assessment of most of the new antiseizure mediations available today. We continue to conduct clinical trials of new epilepsy drugs.
Because of advances in brain imaging, we can now recognize subtle structural brain abnormalities that cause epilepsy. As a result, certain people are now candidates for epilepsy surgery who may not have been considered for this treatment in the past.
- Vagus Nerve Stimulation (VNS): We use VNS for some children and adults with epilepsy whose seizures are not well controlled with medication. We have the most experience in the mid-Atlantic region with VNS - a small pacemaker-like device implanted under the skin in the chest which sends small electrical impulses to the left vagus nerve to control seizures.
- Responsive Neurostimulation (RNS): RNS is a therapy for adults with partial onset seizures that cannot be controlled with medication. Surgeons implant the RNS device into the skull. Electrodes placed on the brain detect abnormal electrical activity. The RNS device then responds by delivering electrical stimulation to normalize brain activity before a seizure occurs.
- Minimally Invasive Surgery: For people with clearly localized seizure sites (foci) that may be difficult or risky to access with traditional surgery, we offer minimally invasive techniques called laser interstitial thermal therapy (LITT- also known as laser ablation) and stereotactic radiosurgery (SRS). Using computer-guided navigation, both of these techniques allow the surgeon to attempt to eliminate the seizure focus without making a large opening in the skull. Aided by MRI, the surgeon guides a laser through a three-millimeter incision and into the focus of a seizure to destroy the brain tissue causing seizures. Most people are able to go home the next day.
- Traditional Surgery: For many people with epilepsy, their best chance of becoming free of seizures is to identify and remove the area of the brain where their seizures are arising. Our surgeons perform these surgeries with great success and have pioneered new techniques. We use brain mapping before and during surgery to carefully define regions of the brain near the area being considered for surgery. We may interrupt nerve fibers on the surface of the brain that carry the signals causing epilepsy symptoms, or remove the specific area of the brain that is triggering seizures.