Inside the EEG monitoring room

Comprehensive Epilepsy Center

CHI Health Immanuel Epilepsy Center is designated as a Level 4 Epilepsy Center by the National Association of Epilepsy Centers (NAEC)

This is the highest designation possible. It means that the Epilepsy Center has the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.

  • Over 3 million Americans have epilepsy.
  • About 200,000 new cases are diagnosed annually in the United States.
  • There are about 20,000 patients with epilepsy in Nebraska.

Epilepsy Tests

Patients with seizures require two tests – Brain MRl and an EEG. 

Magnetic Resonance Imaging (MRI): An imaging technique that utilizes a special seizure protocol to identify abnormalities of the brain.

  • Positron Emission Tomography (PET): This scan assesses the metabolism of the brain. The malfunctioning area (seizure focus) of the brain doesn't utilize glucose as well as the rest of the brain, and thus can be easily identified.
  • Single Photon Emission Computed Tomography (SPECT): This scan assesses the blood flow to the brain. The brain autoregulates its blood supply. The area of the brain that triggers seizures has a decreased blood flow when the patient is not having a seizure and an increased blood flow during a seizure.

Electroencephalography (EEG:

  • Routine EEG: a short, 20-30 minute recording of the electrical activity of the brain. Routine EEGs generally place around 23 electrodes on the scalp.
  • Video EEG (VEEG): A prolonged recording of the electrical activity of the brain that is performed as an inpatient and lasts 3-4 days. There are roughly 30 electrodes placed on the scalp.

Epilepsy Treatments

The main treatment for Epilepsy is medications and almost 60% of patients respond to medications. Those who do not respond to initial treatment require further work up as described below.

  • Wada Test: This test is only undertaken if a patient is a candidate for epilepsy surgery. A Wada test localizes a patient’s language and memory functions. First, a cerebral angiogram is done to determine the circulation. A drug is then injected to “deaden” one hemisphere of the brain at a time, and a standardized memory and language test is administered to determine the required information.
  • Intracranial Video-EEG Monitoring: This procedure is only performed in a select few patients where further localization is needed to clearly delineate the seizure onset area. It involves intracranial monitoring. During the procedure, a flap of the cranial bone is removed so that electrodes can be placed directly on the brain to localize the seizure onset area.
  • Epilepsy Surgery: This involves the actual surgical procedure to remove the seizure focus.
  • Vagal Nerve Stimulation (VNS): This is an FDA approved form of treatment for medically refractory epilepsy. A VNS involves implanting a pacemaker into a patient’s chest. Leads are placed on the vagal nerve in the neck which sends frequent electrical impulses to the brain to alleviate seizures.