Diagnosis begins with our taking a detailed medical history of the patient, including a description of the type and frequency of seizures, the patient's age when seizures began, etc. The experiences and observations of family members are included so that we can acquire as much information as possible. The patient then undergoes basic testing and diagnostic evaluation, including advanced neuro-imaging and EEG. Additional diagnostic testing may then be done, as appropriate.

We provide diagnostic procedures in dedicated, state-of-the-art rooms for both adult and pediatric patients. Long-term monitoring for adult patients is performed on Rhode Island Hospital’s adult neurology floor. Pediatric long-term monitoring is performed in an area of Hasbro Children’s Hospital that is equipped to allow patients to move from their bed to the nearby playroom or schoolroom while still on the monitor.

Testing Options

Non-Invasive

• EEG is used to detect disturbances in the brain's electrical activity. The patterns recorded can help confirm the diagnosis of epilepsy, identify the type of seizure, and locate the brain region(s) where seizures originate.

• Long-term video EEG monitoring helps further identify the type of seizures a patient is having and the region(s) of the brain where they occur. Rhode Island Hospital is the only place in southeastern New England that provides long-term (one to seven days or longer) 24-hour video-EEG monitoring. During this time, typically several seizures are recorded in a safe, supervised setting, in a room equipped for this purpose.

• MRI provides excellent images that help locate abnormalities in the brain. Functional MRI (fMRI) permits mapping out key areas of the brain that may affect surgical planning, such as language or motor areas.

• SPECT uses a radioactive tracer to map blood flow to the brain and compare blood flow during seizures with blood flow when seizures are not occurring. During a seizure, there is usually increased blood flow to the part of the brain where the seizure starts.

• PET scans use a radioactive isotope to map the use of glucose in the brain. Areas of the brain associated with seizures sometimes use less glucose, helping to identify which part of the brain is responsible for causing seizures.

• Neuropsychological testing is used to assess memory and other cognitive skills and deficits.

The WADA Test

• The  WADA Test is an angiogram-based test of one half of the brain (one hemisphere) at a time. During the WADA procedure, a sedative is used to slow activity in one hemisphere of the brain at a time in order to help in assessment of the risk of memory impairment after surgery. This test also enables us to identify which hemisphere of the brain supports language. Test results are beneficial for surgical planning.

Intracranial

• Phase 2 or intracranial EEG monitoring is done using strips or grids of electrodes placed on the surface of the brain or depth electrodes placed within the brain. Long-term video-EEG monitoring is conducted with these in place for up to 14 days, allowing for a more precise mapping of where seizures originate in the brain as well as of where critical sensorimotor, language, and visual areas are located, which is vital for surgical planning.

• Electrocorticographic (ECoG) monitoring records directly from the brain with surgically applied grids and strips of electrodes and helps in mapping where seizures occur in the brain and where critical sensorimotor, language, and visual areas are located.

• Stereoelectroencephalography (SEEG) provides a 3D neurological image of brain activity, using small precisely implanted electrodes to identify brain areas responsible for causing seizures.

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