Frequently Asked Questions
As a patient, you may have many questions concerning testing and treatment at the Sutter Pacific Epilepsy Program. We hope this list of frequently asked questions will address your concerns. If you have additional questions please do not hesitate to speak with your physician.
- Video-EEG Monitoring
- Other Testing
- Your Hospital Stay During Evaluation
- After the Diagnosis is Made
- Intracranial Electrodes
- The Surgical Evaluation
- EEG Recording
- Other Tests During Surgical Evaluation
- Going Home After Evaluation
- Wada Test
- Epilepsy/Seizure Surgery
- Postoperative Concerns
Q - Why am I being admitted for video-EEG monitoring?
A - There are several reasons your doctor may suggest that you be admitted to the hospital for continuous monitoring. Monitoring allows your doctor to see precisely how many seizures you are having. It can also tell your doctor which drugs might be best for you by determining exactly what type of epilepsy you have. If you are being considered for epilepsy surgery, monitoring is necessary to locate the area where your seizures begin.
Q - What does it mean to be admitted for video monitoring?
A - You will have EEG electrodes placed on your scalp 24 hours a day for approximately three to seven days. Special electrodes called sphenoidal electrodes may also be used. These are thin wires that your doctor will insert in the cheek area. The electrodes are near the undersurface of the brain and record brain activity that cannot be detected by ordinary electrodes. Placement of these electrodes may be briefly uncomfortable.
All the electrodes are connected to the EEG monitoring equipment. A video camera is mounted in your room so that the doctors can record what happens to you physically when a seizure occurs and then compare this to the electrical seizure activity.
Q - How long will I be in the hospital?
A - The average length of stay is from three to seven days.
Q - Can I get out of bed?
A - Yes. With your physician's approval and assistance from your nurse or other healthcare professional, you may get out of bed to sit in a chair and move around your room, but make sure that you are still connected to the monitor and in view of the camera. Your medical team will assist you with your daily needs such as bathing, grooming, using the restroom, meal selections, and exercising.
Q - Must I stay in my room?
A - Yes. The monitoring equipment does not allow you to leave your room. In order to leave your room, it is necessary that you be disconnected from your monitoring equipment. This can only be done with your physician's written request.
Q - What if I don't have seizures when I'm in the hospital?
A - As part of this inpatient evaluation, you will be tapered off your seizure medication and sleep deprivation may be required to induce seizures.
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Q - What other testing will I have while in the hospital?
A - If you have not already had them, you will have an MRI and a PET scan. Sometimes a SPECT scan and neuropsychological tests may be done.
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Your Hospital Stay During Evaluation
Q - What should I bring with me to the hospital?
A - We encourage you to wear your regular clothes during the day and your pajamas at night. Clothes with buttons or zippers are best. The electrodes and wrappings on your head make "pull-on" shirts difficult. We encourage you to bring your favorite hobbies and plenty of reading material. Some patients find that photographs or a special pillow or blanket make the room more comfortable. For safety reasons we ask that all personal items and effects be cleared through your epilepsy team.
Q - Do I have to share a room?
A - All accommodations in the epilepsy unit are private rooms.
Q - Can I wash my hair?
A - No, not while you have the electrodes on.
Q - May I have visitors?
A - Yes. Visiting can be good medicine for patients. Family members and friends are always welcome to visit. Normal visiting hours are from 11:00 AM to 8:00 PM, however hours are flexible.
General visiting guidelines:
- Please remember if you have a cold, sore throat, or are generally not feeling well, you should not visit patients.
- To protect our patient's privacy and to ensure patient confidentiality, visitors may be asked to leave the room during tests or treatments or when the doctor or nurse needs to see the patient.
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After the Diagnosis is Made
Q - What happens once we find what we are looking for?
A - If you are here for a diagnosis, you will be discharged home and return to the Center for a follow-up visit or be seen by your referring physician.
If you are here for a surgical evaluation, you will be disconnected from the monitoring equipment, your medication will be resumed, and you will be discharged once the blood level of your medicine is adequate. The team will review all hospital findings to determine the area in the brain where your seizures begin. If we are able to identify the exact location of your seizures, you will have a Wada test.
If we cannot find the focus, you will be discharged and may be readmitted later for evaluation with intracranial electrodes.
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Q - What is the purpose of intracranial electrodes?
A - Intracranial EEG electrodes are necessary when the scalp EEG recordings of your seizures do not give us the information needed to localize your EEG focus. The number, type and placement of electrodes are based on the appearance of your seizures. The names of the different types of intracranial electrodes that may be used are depth electrodes, subdural strips, and subdural grids.
Q - What are depth electrodes?
A - They are very fine electrodes (wires) that are placed inside the brain to record electrical activity.
Q - How are the electrodes inserted?
A - If you are having depth electrodes placed, you will be fitted with a stereotactic head frame and taken to the MRI where they will help the neurosurgeon map out the coordinates so that the electrodes are placed in the correct position. You will then return to the operating room where the neurosurgeon will make several small holes in your skull, through which he will place the electrodes. The electrodes are then sutured in place and your head wrapped in a bandage for protection and padding. For subdural strips or grids, you are taken directly to the operating room.
Q - What are subdural strips?
A - They are strips of six to eight contact points from which electrical activity from your brain is recorded. They lie on the surface of the brain rather than in the brain tissue. A small hole may be drilled in the skull in order to place the strip electrodes.
Q - What are subdural grids?
A - A subdural grid is an array of up to 64 contact points from which we can record the brain's electrical activity. It is placed on the surface of the brain through a craniotomy incision. The grid can also be used to map out speech and motor areas to help guide the surgeon in the resection. A circle of skull (craniotomy) is temporarily removed in order to place grid electrodes.
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The Surgical Evaluation
Q - Will my head be shaved?
A - Part of your head will be shaved to protect you from infection.
Q - How will I feel after the electrodes are placed?
A - You may have a headache for the first day or two and you may notice some scalp and eyelid swelling. Sometimes, a small amount of clear spinal fluid may leak out through the incision for several days. This is not dangerous to you and will subside.
Q - How long does the surgery last?
A - From the time you leave your room until the time you are in recovery will be approximately four to six hours.
Q - What can I do after the surgery?
A - After 24 to 48 hours you will be able to get out of bed and sit in a chair or take a walk with a nurse.
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Q - When will the EEG recording begin?
A - Within 24 to 48 hours after the electrodes are inserted.
Q - Are there any risks?
A - There is a small risk of infection and brain hemorrhage or swelling that may result in weakness. As with any surgery, there is a very small risk of complications from the anesthesia. You may also have difficulty opening your mouth wide for two to three days after surgery.
Q - How long will I be in the hospital?
A - That will depend on the number of seizures you have. The average length of stay is ten days.
Q - What if I do not have any seizures?
A - Your medication will be reduced and stopped just as in your initial evaluation. Seizures may also be induced by sleep deprivation.
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Other Tests During Surgical Evaluation
Q - What other tests will be done during the surgery evaluation?
A - We may stimulate the electrodes with tiny electrical currents in order to map out important areas of function in your brain such as speech and motor areas. This is done by the doctor in your room. You will be asked to read and do certain tasks to help define these areas.
Q - When will the electrodes be removed?
A - The electrodes will be removed once you have had enough seizures to determine the area where the seizures begin. This will be done in your hospital room or in the operating room.
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Going Home After Evaluation
Q - When can I go home?
A - Once you are taken off the monitoring system, your medicine will be adjusted. If you are not scheduled for surgery at this time, you will be discharged once the blood level of your medicine is adequate.
Q - What can I do when I go home?
A - You can do anything you wish as long as you feel up to it. You can return to work and/or school after several days. You can discuss other issues with your nurses or doctors.
Q - What happens next?
A - The epilepsy team will review all of the findings from your hospitalization. They will decide at this time whether you are a candidate for epilepsy surgery.
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Prior to surgery, you will be scheduled for a Wada test. This test usually requires that you remain at the medical center from early morning to early evening.
Q - Why am I having this test?
A - We have established where in the brain your seizures begin, and want to make sure that if we remove a portion of the brain, your speech and memory abilities will not be affected.
Q - How long does the Wada last?
A - It lasts approximately one-and-a-half hour, but you will be in the hospital six to eight hours.
Q - What does the Wada test consist of?
A - A catheter is inserted into the artery in the right groin region and then threaded up to the carotid artery in your neck. A dye is injected into the catheter that illuminates the blood vessels in your head. The dye is injected twice so we can look at both sides of the brain.
After this, we connect you to an EEG machine. The medicine (amobarbital) is injected into the catheter to put half of your brain to sleep. We will ask you several questions and ask you to remember certain words, objects and designs. We will wait about 45 minutes and inject the medicine into the other side and repeat the testing.
Q - What are the risks of this procedure?
A - The risks are minimal. You have less than a one-percent chance of having a stroke. There is also a risk of infection and an allergic reaction to the dye. If you have any allergies to iodine or shellfish, you must notify your doctor before the test.
Q - What can I do after the Wada test?
A - We ask that you lie in bed with your right leg straight for six to eight hours after the test to prevent bleeding from the area where the catheter was inserted. After that you are able to get up. You may also eat and we encourage you to drink lots of liquids.
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Q - Why am I a candidate for epilepsy surgery?
A - You are a candidate because your seizures have not been controlled with medication, and we have determined where your seizures begin.
Q - What are the seizure operations?
A - Most often, seizures are located in the temporal lobe because it is an area in the brain very susceptible to injury. An operation called temporal lobectomy removes part of that region in order to control the seizures.
Seizures begin in other regions of the brain less frequently. After determining that it is safe, these epileptic regions often can be removed.
A third type of operation is called corpus callosotomy. In this surgery, the connections between the two halves of the brain are severed. This prevents seizures from spreading from one half of the brain to the other. Although the seizure region is not removed, the seizures remain small and falling seizures are reduced in number and severity.
Q - Will the surgery stop my seizures completely?
A - The percentages vary depending on your individual case and the type of surgery you have. Your doctor will discuss your case with you individually.
Q - What are the risks of surgery?
A - Complications include a very small risk of paralysis of an arm or leg, or loss of vision on one side. There is a small risk of an infection resulting in a stiff neck and some confusion that will clear with treatment. Side effects from surgery include temporary problems resulting from brain swelling after surgery. The swelling may produce a mild weakness of an arm or leg, difficulty with finding the right words, and loss of a tiny part of your field of vision. These symptoms get better as the swelling is reduced.
In approximately 25 percent of patients, psychiatric symptoms may occur. These symptoms can include depression, hypomania (a state of increased anxiety) and hallucinations. These symptoms can occur anytime within the first several weeks after surgery. The depression and increased anxiety can occur anytime within the first several months after surgery. All of these symptoms are temporary and respond well to treatment.
Q - How long does surgery last?
A - Approximately five hours.
Q - Will I be asleep during surgery?
A - Usually you will be asleep, although in certain situations your doctors may ask you to remain awake (but sedated) for a portion of the operation.
Q - How will I feel after the surgery?
A - You will have a headache for several days and may be nauseated. Some patients complain of neck and backaches as well. You may have a black eye and facial swelling. You should feel much better by the third day and feel ready to go home by the fourth to seventh day.
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Q - What problems could I have right after I go home?
A - Sometimes people find that their emotions go up and down over the first few weeks to months after surgery. Some people may become "blue" or depressed, while others may become excited or elated. The symptoms are temporary but may require a brief course of mood stabilizing medication.
Q - Will I have any long-term problems after surgery?
A - Your doctor will be able to tell you what the risk is for you. Some people may experience problems with some aspects of memory after surgery, but this is usually only noticed with sophisticated memory testing. Most patients feel better and not as lethargic, as their level of medication may not be as high.
Q - Will I ever be off medication?
A - If you choose, we will attempt to withdraw your medication two to five years after temporal lobectomy surgery. Studies are being conducted to determine the risk of seizure recurrence once medications are stopped. At this time we are unable to tell you how likely it is that you will have a seizure if your medications are stopped.
Q - Will I be able to drive after surgery?
A - This decision is made by the Department of Motor Vehicles, but most patients have their license reinstated within twelve months after the surgery if they are no longer having seizures.
Q - Will my hair grow back?
A - Yes. Your hair grows approximately one half an inch per month and will remain the same color and texture. The scar will be hidden completely by your hair.
Q - When can I go back to school or work?
A - We usually encourage people to tell their school or employers that they can return to school or work six to eight weeks after surgery.
Q - What can I do after I go home?
A - You should take it easy, go for a few short walks and build yourself up slowly. No heavy exercise, and no lifting.
Once you are home, if you have any problems or questions please call your physician. Do not wait for your visit to the doctor. Make sure you schedule a return visit to see the neurosurgeon and the neurologist in two weeks.
The post-operative care and testing is a very important part of your evaluation and treatment. For this reason, we will need to see you three months, six months, and one year after your surgery, and annually thereafter. Neuropsychological testing may be done one year after surgery.
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