Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (eg, for presurgical localization), each 24 hours
CPT4 code
Name of the Procedure:
Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (e.g., for presurgical localization), each 24 hours.
Summary
This procedure involves continuous monitoring of brain activity using EEG and simultaneous video recording. It helps in pinpointing the source of seizure activity in the brain, primarily for evaluating patients who may require surgery to treat epilepsy.
Purpose
This procedure is used to identify the specific location in the brain where seizures originate. The primary goal is to determine whether a patient with epilepsy is a candidate for surgical intervention, potentially offering relief from seizures when medication is not effective.
Indications
- Patients with epilepsy not controlled by medication.
- Unclear origins of seizure activity needing precise localization.
- Pre-surgical evaluation for epilepsy surgery.
- Frequent and severe seizures.
Preparation
- Patients may need to adjust or halt certain medications as directed by their physician.
- Ensure adequate rest prior to the procedure but might also be asked to be sleep-deprived.
- Routine diagnostic tests, such as blood work, may be required.
- Patients should follow specific instructions about food, drink, and hair cleanliness to ensure good electrode contact.
Procedure Description
- Electrodes are placed on the patient's scalp.
- Continuous EEG monitoring records brain electrical activity via these electrodes.
- Simultaneous video recording tracks physical activity and facial expressions.
- Data is transmitted through cables or radio telemetry to a monitoring system.
- A trained neurologist interprets the recorded data to locate seizure foci.
- The procedure is repeated over a 24-hour period.
Duration
Each session of the procedure lasts 24 hours.
Setting
The procedure is typically performed in a hospital or specialized epilepsy monitoring unit.
Personnel
- Neurologist or epileptologist.
- Technicians for EEG setup and monitoring.
- Nurses providing care and support.
- Video monitoring staff.
Risks and Complications
- Skin irritation from electrode placement.
- Rare risk of data loss or equipment malfunction.
- Potential discomfort from prolonged monitoring.
- Seizure might occur during monitoring, requiring immediate medical attention.
Benefits
- Accurate localization of seizure focus, facilitating possible surgical treatment.
- Improved treatment plans based on precise data.
- Potential for significant reduction in seizures post-surgery.
Recovery
- Minimal recovery time needed.
- Discomfort related to electrode placement may persist briefly.
- Instructions may include care for skin irritation spots.
- Follow-up appointments to discuss results and further treatment options.
Alternatives
- Standard EEG without video, which may be less comprehensive.
- MRI or PET scans to locate brain abnormalities.
- Medication adjustments or other non-invasive treatments, though these may not provide as precise localization.
Patient Experience
- Patients need to stay in the monitoring unit for an extended period, limiting mobility.
- May experience mild discomfort from the electrodes and restricted movement.
- Pain management isn't typically required, but comfort measures include frequent position changes and accommodations for daily needs.