• History and physical exam — The neurologist will take a log of the patient’s medical history and family history. A number of questions will be asked regarding previous drug and alcohol use. Tests will be performed to assess the function of muscles, senses, reflexes and coordination. These tests are extremely important for proper diagnosis.
• CAT-scan (CT scan) — A CAT scan creates images of the brain using radiation and computer technology.  Sequential “slices” of the CT scan can demonstrate irregular activity in the brain such as hemorrhage, tumor, or infection.
• Electroencephalogram (EEG) — An EEG is used to diagnose epilepsy by recording the electrical activity of the brain. The EEG shows patterns of normal or abnormal brain electrical activity.
• Ictal SPECT scan — An Ictal SPECT scan is a study that is performed in people whose epileptic seizures are very frequent or predictable. SPECT stands for “single photon emission computed tomography” and measures blood flow in the brain and “ictal” means that it is performed during a seizure. This test is performed by injecting a radioactive substance immediately after a seizure begins. After the substance travels to the area of the brain where seizures originate, a special camera detects the location of this substance in the brain, thus showing the location of the focus.
• Magnetic Resonance Imaging (MRI) — MRI stands for “magnetic resonance imaging,” provides detailed pictures and can pinpoint structural abnormalities in the brain. Certain brain structures are commonly abnormal in persons with epilepsy; these can be best detected when the MRI is performed with special epilepsy protocols. Individuals with epilepsy require a special type of MRI to locate subtle structural abnormalities that can cause seizures. The most subtle abnormalities are more likely to be detected with high-strength MRI scanners. The strength of an MRI is measured in units called “Tesla,” and 3-Tesla MRI’s are the most advanced units available.
• Magneto-encephalography — or MEG, can help find brain areas that show abnormal electrical activity. The MEG is more precise than an EEG at finding irritated areas of the brain, but it cannot be used to record a seizure like the EEG. Based upon the results of the video EEG, some patients will be referred for an MEG, which is an outpatient procedure.
  
• PET Scan — PET stands for “positron-emission tomography,” a procedure where a small amount of radioactive glucose (sugar) is injected into a vein to allow a radiation-detecting camera to record brain images. These pictures show how and where the brain uses energy. Epilepsy can cause changes in the way the brain uses sugar, and this change, which is detected with a PET scan, can help pinpoint the epileptic focus.
• Video Electroencephalogram (Video EEG) — The patient is videotaped at the same time the EEG is performed. The recording is typically carried out for an extended period of time. Video EEG is most helpful in determining whether seizures with unusual features are actually epilepsy, identifying the type of seizures and pinpointing the region of the brain where seizures begin.
• Wada testing — Sometimes a Wada test is necessary prior to brain surgery. This test is performed by injecting a drug, called amytal, via a catheter to temporarily put one side of the brain to sleep in order to test the function of the other side that is still awake. This allows a neuropsychologist, working with a neuroradiologist, to test functions of the right and left sides of the brain individually. The Wada test can determine how each side of the brain performs important brain functions like language and memory. This test also helps to determine the safety of undergoing brain surgery. Prior to undergoing a Wada test, patients meet with a neuropsychologist who explains the procedure in detail.

Video Electroencephalography (EEG) Monitoring Unit

Video EEG is a study that is used to monitor someone who has a presumed seizure disorder that is not appreciated on a regular surface EEG. Video EEG looks at and records brain-wave activity and the effect this activity has on the body. Video EEG helps the neurologist classify the seizure type, localize the seizure activity and design a treatment plan. Video EEG is also helpful in monitoring the effects of anticonvulsant medication titration (changes).

Long Island Jewish Medical Center, North Shore University Hospital, Southside Hospital and Huntington Hospital are all capable of performing Video EEG monitoring on an inpatient basis. The goal of performing this type of testing is to provide a safe and comfortable environment for continued Video EEG monitoring for patients who are undergoing an epilepsy workup.

This study usually takes between one to seven days. If diagnostic brain-wave activity is appreciated, the neurologist will determine when it is most appropriate to be discharged.

Video EEG is a painless exam that involves placing electrodes on the head with gauze and a special cream. This cream will harden after application to help prevent the electrodes from disconnecting. The device will then be placed in the patient's room and continuously monitor them.

If you are about to undergo Video EEG monitoring, be sure to remember to do the following:

• You must shower, shampoo and dry your hair prior to arrival. Do not use any styling products,conditioners, hairspray, gel or mousse. Do not tease your hair or accessorize it. You will not be able to shower once the study begins.
• Hair braids, weaves or extensions must be removed prior to arrival.
• Refrain from caffeine products (tea, coffee, cola, chocolate) for 24 hours prior to study.
• Stay up two to three hours past normal bedtime.
• Please do not wear any perfume or cologne.
• Remove earrings prior to arrival.
• Wear something you will feel comfortable in. Button-down shirts are generally more comfortable. No scarves or woolen caps.
• Take prescribed medications, unless otherwise instructed by your neurologist.