The goal of this phase is to locate, as best as possible from scalp recordings, where the seizure starts. Medications are often reduced, as the plan is to facilitate seizures happening while under EEG and video monitoring.

In addition to EEG-video monitoring, patients may have additional testing that includes head MRI, PET, head SPECT, qEEG (BEAM), and neuropsychological testing. Neuropsychological evaluation involves tests that are specific to the function of certain brain regions. Often an epileptic focus is in a brain region with abnormal function.

A child may undergo the following tests to assist in locating the source of the seizures and determine if it can be safely removed:

• MRI: An MRI provides a physical image of the brain. Sometimes, the cause of seizures is associated with anatomical abnormalities that are visible in an MRI.
• SPECT and PET: SPECT and PET provide a metabolic brain image and are obtained by administering a harmless radioactive tracer through an IV.
• qEEG: Interictally (when not having a seizure), metabolic activity is reduced in the area of an epileptic focus. During a seizure (ictally), metabolic activity may be increased in the focus. qEEG can mathematically calculate, from scalp data, the most likely internal source of spikes and waves in three dimensions.

The goal is to be absolutely sure where the epilepsy is coming from by directly measuring the brain.

If the focus is confirmed, the patient can undergo surgery to remove the electrodes and the abnormal brain region. In some cases, an epileptologist who is in the operating room performs an electrocorticogram (EcoG or EEG from the brain surface) to guide the neurosurgeon.

We take every precaution to minimize the risk of producing a functional deficit after surgery. Prior to surgery, certain tests may be performed that include evoked cortical potentials, cortical stimulation, and WADA testing. During the procedure, surgeons avoid speech centers, memory areas, and cortex controlling crucial motor or sensory functions. Most patients function normally after surgery.

Corpus callostomy

The first surgical option is referred to as corpus callostomy. In children with severe and damaging drop attacks, we can cut the major white matter tract that connects the two halves of the brain (hemispheres), electrically separating the hemispheres of the brain. Corpus callostomy rarely produces problems with behavior, cognition, or motor function.

Vagal Nerve Stimulation

We also offer Vagal Nerve Stimulation. Here a small electric stimulator (much like a heart pacer) is placed under the skin below the left collarbone. Stimulation of the vagus nerve (a nerve in the neck) may reduce seizures in children with intractable epilepsy.