Brooklyn Methodist Hospital Services

NewYork-Presbyterian Brooklyn Methodist Hospital

Pediatric Neurology

Epilepsy

What is a seizure? A seizure is a sudden disruption of the brain's normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations. (Seizures that are not caused by a fever occur in 1 to 2% of children.)

When people have a tendency to experience seizures, we say they have a seizure disorder. What happens in the brain during a seizure is the same as in someone with epilepsy, but epilepsy by definition, is described as two or more seizures.

What we provide

Diagnosis of a seizure disorder/epilepsy requires many components which must fit together in order to eliminate other medical conditions that also cause seizures. The most important part of the diagnostic puzzle is a detailed description of the seizure and the child's general medical history. In the absence of other positive findings, a diagnosis may be made on history alone.

Neurological tests such as electroencephalogram (EEG) are used to determine seizure type and which area of the brain may be involved in the seizures. An EEG is a 30 to 60-minute test that measures the brain's electrical activity. In an EEG, a technician uses sticky paste to apply 16 to 20 small metal discs called electrodes in different positions on the scalp, covering multiple areas of the brain. The electrodes are connected by wires to a recording machine that detect and records patterns of electrical activity and checks for abnormalities.

Standard and sleep deprived EEGs are performed without sedation by an experienced technologist.

Video EEGs (long term monitoring), where an individual is videotaped at the same time that the EEG is recorded may also be ordered. The recording may be carried out for 24 hours or more. As this test is usually performed in the hospital, your child will be admitted for the duration of the test. The doctor usually views the video and EEG images side by side on a split screen. This allows the doctor to see precisely how a child's behavior during seizures is related to the electrical activity in the brain. Video-EEG is helpful in identifying the type of seizures, determining whether seizures with unusual features are actually epilepsy, pinpointing the region of the brain where seizures begin, and choosing proper treatment.

Ambulatory EEG may also be offered when appropriate.

Children who have seizures which are resistant to medical therapy are further evaluated with additional tests (SPECT, PET) in consideration for non-medical therapy such as vagal nerve stimulation or epilepsy surgery.