Name of the Procedure:

Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (EEG) recording and interpretation, each 24 hours

Summary

This procedure involves continuous monitoring using an electroencephalogram (EEG) to record the brain's electrical activity over a 24-hour period. It helps to identify and pinpoint the origin of seizures within the brain.

Purpose

The procedure addresses epilepsy and other seizure disorders. The goal is to determine the location and pattern of seizure activity, which is critical for diagnosing the specific type of epilepsy and planning appropriate treatment.

Indications

• Unexplained seizures
• Suspected epilepsy
• Poorly controlled seizures despite medication
• Pre-surgical evaluation for epilepsy surgery

Patients experiencing frequent or severe seizures that impact their daily life or those who have not responded to standard treatments are typically candidates for this procedure.

Preparation

• Patients may be asked to reduce sleep the night before the test to increase the likelihood of recording seizure activity.
• Certain medications may need to be adjusted or stopped under medical supervision.
• Hair should be clean and free of any styling products to allow for proper electrode placement.

Procedure Description

1. Electrode Placement: Small metal discs (electrodes) are applied to the scalp using a special adhesive.
2. Continuous Monitoring: The patient is monitored continuously for 24 hours. This may occur in a hospital setting where video recording can also be performed to correlate physical activities with EEG data.
3. Data Collection: The EEG records electrical activity in the brain through multiple channels (at least 8).
4. Data Interpretation: A neurologist will review the collected EEG data to identify and lateralize seizure activity.

No anesthetics or sedatives are typically used, as they can interfere with the brain's activity recording.

Duration

The procedure involves continuous monitoring over 24 hours.

Setting

The procedure is usually performed in a hospital setting, often within a specialized epilepsy monitoring unit.

Personnel

• Neurologist or epilepsy specialist
• EEG technologist
• Nursing staff

Risks and Complications

• Minor skin irritation where electrodes are attached
• Discomfort from prolonged monitoring
• Rarely, the procedure may induce a seizure, which will be managed by medical staff on-site.

Benefits

• Accurate localization of seizure focus, aiding in the precise diagnosis and treatment planning.
• Potential identification of triggers or specific patterns of seizure activity.
• Enhanced ability to tailor medical or surgical treatment for better seizure control.

Recovery

• Minimal recovery time needed, as the procedure is non-invasive.
• Patients can usually resume normal activities immediately after electrode removal.
• Follow-up with the neurologist to discuss findings and treatment adjustments.

Alternatives

• Routine EEG, which records brain activity over a shorter period but may miss intermittent seizure activity.
• Advanced imaging techniques like MRI or PET scans, although these may not provide the same detailed functional information as an EEG.
• Remote or home EEG monitoring for those who cannot be admitted for in-hospital monitoring.

Patient Experience

During the procedure, patients can expect to have electrodes attached to their scalp and remain under continuous observation. Some may find the extended monitoring period uncomfortable, but pain is minimal. Comfort measures include ensuring the patient has access to normal activities like reading or watching TV while being monitored.