"As a result of our dedication to the diagnosis and treatment of epilepsy, we provide a wealth of state-of-the-art diagnostic services as part of our comprehensive program."

EEG

A full range of electrophysiologic testing is available. Both the Harper Hospital and Children's Hospital of Michigan EEG Laboratories can perform routine awake and asleep EEGs as well as prolonged (four or eight hour) studies with or without concurrent video monitoring. Standard scalp electrodes can be supplemented with special electrodes, such as sphenoidal electrodes, if indicated. Long term video EEG monitoring is available 24 hours a day in two dedicated beds in the adult Epilepsy Monitoring Unit (EMU) located at Harper Hospital and in three dedicated beds in the pediatric EMU at Children’s Hospital of Michigan. These innovative systems combine the most technologically advanced video EEG recording capabilities with continuous on line seizure detection software. Specially trained epilepsy nurses perform neurological testing during seizure events. EEG technologists are available 24 hours a day to monitor the patient closely. The Epilepsy Monitoring Unit is set up as a therapeutic community. Private rooms are arranged for patient comfort. For purposes of entertainment and exercise for patients during their stay, each room includes a videotape player and stationary bicycle. The referring physician will find video EEG monitoring helpful in several clinical situations. This technology can establish the electrical nature of questionable clinical events and is also useful: in the quantification of seizures in the classification of seizure type and in the evaluation of patients for epilepsy surgery In most cases, patients remain in the Epilepsy Monitoring Unit until they have had several of their typical seizures, usually two to seven days.

BRAIN IMAGING TECHNOLOGY

"As faculty members of one of the most advanced medical centers in the midwest and the Wayne State University School of Medicine, our epilepsy experts have at their disposal a host of the most technologically advanced imaging modalities currently available to medical science. Such state-of-the-art imaging studies enable our specialists to provide a thorough evaluation of the patient. "

MRI and MRS
 

Magnetic resonance imaging (MRI) technology continues to evolve at the Detroit Medical Center. In addition to standard sagittal, axial, and coronal MRI images, high resolution, thin (1.5 mm) section spoiled gradient echo sequences allow exquisite visualization of the medial temporal lobe structures that are often damaged in intractable temporal lobe epilepsy. These images can be transferred to a computer work station for quantitative volumetric analysis which is a powerful tool in detecting hippocampal sclerosis, the most common cause of temporal lobe epilepsy. These high resolution images also allow visualization of other small structural processes such as cryptic vascular malformations or neuronal migration disorders that can cause seizures.

Magnetic resonance spectroscopy (MRS) allows metabolic imaging of brain structures by the detection of biochemical constituents and biochemical changes in the brain. This technique is available at the Detroit Medical Center and is becoming a powerful clinical tool in the detection of the site of seizure onset.

PET
 

Positron emission tomography (PET) scans represent functional images of the brain. Studies performed with radiolabeled glucose assess brain metabolic activity. Epileptogenic cortex correlates with areas of reduced metabolism and relatively decreased uptake on PET scan. New probes such as Flumazenil assess the presence of receptors for neurotransmitters such as those associated with GABA in the brain and are proving to be quite helpful in localizing the site of seizure onset. Brain mapping with PET and [O-15]-labeled water is a powerful means of localizing vital motor and language functions in the brain, so that these can be preserved during surgery.

SPECT

Single photon emission computed tomography (SPECT) scans measure brain blood flow, which is an indirect indicator of cerebral metabolic rate. Interictal SPECT scans tend to show decreased blood flow to the epileptogenic cortex, although this technique has not been sufficiently specific to become a reliable diagnostic tool. However, SPECT scans obtained at the time of a seizure (isotope injected during a seizure, scan obtained later) show excellent sensitivity and specificity for the epileptogenic cortex. Within the Epilepsy Monitoring Unit, nurses are trained to deliver the isotope at the time of the seizure. The scan can be obtained within the next several hours in the Nuclear Medicine Department.  Ictal SPECT scanning has been incorporated into the protocol for localization of the epileptogenic region.

Functional brain mapping is performed acutely in the operating room and chronically with surgically implanted electrodes. Somatosensory evoked potentials recorded from electrodes applied directly to the cerebral cortex identify sensory cortex. Electrocorticography defines the epileptogenic region by recording EEG activity directly from the cerebral cortex. Direct cortical stimulation establishes the margins of eloquent cortex, allowing epilepsy surgery to be performed with a high margin of functional safety.