What you need to know when you come to the M.N.H.
Epilepsy is a chronic neurological disorder characterized by recurring seizures. For patients who cannot control their seizures with medications, epilepsy surgery may provide a possible treatment option.
Suitable candidates are carefully selected based on age, previous medical condition, previous and current medications, seizure type and an in-depth investigation that starts with an in-patient assessment. You are a surgical candidate if your seizures are not well controlled with medication, if we know where your seizures begin and that surgery would not pose significant risk to you. With your collaboration, we are about to look for the cause of your seizures. Your doctors will be using the most sophisticated technology in Quebec. Here is some information to help you to understand the process. After reading it, you should feel better prepared and informed during your stay at the Montreal Neurological Hospital.
Once you arrive on your unit, you will meet your nurse, who will perform a nursing admission. This includes an interview and assessment of your health. You will also be interviewed and assessed by neurology residents. At any time during your hospitalization, you are encouraged to ask questions concerning the plans for your hospital stay. For seizure patients, the length of stay in the hospital is approximately 7 to 10 days..Below are descriptions of some of the tests that you might undergo. The tests have a number of goals:
Your doctor will decide, with you, the best treatment options. We suggest that you read about these tests. As soon as you have one of them, you can mark off the square next to it. In this way, you can follow your own investigation process.
It records electrical activity in the brain through the use of electrodes placed on the surface of your scalp. Recording can be done while you are awake or asleep. It is not dangerous and it does not hurt. By recording electrical activity within the brain, this test helps in identifying where the seizure comes from.
Video telemetry helps to find the location of your seizures. Video telemetry simply means that you will be recorded by a video camera, 24 hours a day, on a specialized unit located on 3 North. During this time, you will be connected to an E.E.G.
Video telemetry also records voices and sounds by using a microphone that is placed in the room.. The images are monitored on screens on 3 North, as well as in the E.E.G. Department. Telemetry technicians will check your electrodes every day.
Video telemetry allows the nurse and the physician to observe your seizures and record the changes of electrical activity during the seizure. The purpose of video telemetry is for you to have a seizure, which can be recorded in a safer environment. It is known that certain activities increase the chances of having seizures. These activities include exercise, sleep deprivation (staying up all night) and decreasing the dosage of your medication. Your doctor will indicate which of these will apply to you. A nurse will remain by your side when you have a seizure. She will attempt to ask you questions about your speech, vision, memory and your ability to move. This is called seizure testing. Naturally, you will answer only as best you can. A special teaching session will be done about video telemetry by your nurse and your E.E.G. technician (when you go onto telemetry).
During your time on telemetry you may experience some itching of your head due to the EEG electrode glue. If this does occur inform your nurse who will give you some medication to help relieve this.
In order for your seizure investigation to be as successful as possible, your cooperation is very important. The more time you spend connected to video telemetry, the better chance there will be of recording as many seizures as possible.
As you will be expected to remain in your room connected to the telemetry equipment, we recommend that you bring items that will prevent boredom (books, cards, knitting, puzzles, videocassette, etc.). There are a few precautions that are necessary:
At various times during your stay, you will have blood taken to measure the level of your medications.
Magnetic Resonance Imaging (MRI)
This examination will permit the visualization of structures such as your brain and spinal cord without exposing you to x-rays. The test can last for up to 60 minutes. For your own comfort, we recommend that you empty your bladder before the test. We ask that you remove all metallic objects such as jewelry and all your credit cards because they will be damaged by the machine. Before this test, you will be asked to sign a consent form.
You will be lying on a platform which will slide into a tube. It is required that you remain completely still, otherwise the quality of the picture image will be affected. You will hear a banging. To decrease the discomfort, earplugs will be made available. At all times, it will be possible for you to communicate with the personnel of the department and for them to see and communicate with you.
Magnetic Resonance Spectroscopy
Magnetic resonance spectroscopy is a technique that provides information about the bio-chemicals in the brain. The scanning procedure takes 45 to 60 minutes. The preparation is the same as M.R.I. During the first part of the exam, you will hear knocking sounds for a few minutes while the scanner makes a picture of your brain and the machine adjusts itself. There are no side effects with this test.
Single Photon Emission Computerized Tomography (SPECT)
For this examination, a radioactive substance will be injected into your veins during a seizure (Ictal spect) and 24 hours or more after a seizure (Interictal spect). There are no side effects to the injection and it will be readily absorbed into the brain. The amount of radioactive substance injected is extremely small. It is roughly the amount of radioactivity received when you travel by plane from Montreal to Vancouver. The second part of the examination is to have a scan. This is done up to 3 hours after the injection. You will lie on your back and the camera will be moving slowly around your head. The doctors will examine the way in which your brain has absorbed the radioactive substance as a means to identify the focus of your seizures.
All patients with seizure disorders who are candidates for elective surgery are assessed with neuropsychological tests. A variety of cognitive tests are administered to understand how various psychological systems (particularly speech and memory) are organized in the brain. These tests show which systems are functioning normally and which may have been damaged by whatever is causing your seizures. These tests also determine any effects that surgery may have on these systems. These tests require a minimum of 4 to 5 hours.
Cerebral angiography is a study of the blood circulation of the brain. It is done under local anaesthesia in the x-ray department. Prior to this test, you need to sign a consent form. A small tube is placed into the artery of your groin and it is then advanced into the arteries of the neck. Injection of a contrast substance through this tube will show your brain circulation. This test can last up to 2 hours, depending on how many arteries are being examined.
WADA Test for Speech Organization and Memory Function
This test is scheduled for all patients who:
Testing is done on two consecutive days, usually the brain’s right hemisphere on the first day and the left on the second. The test occurs at about 11 a.m. Patients may have a light breakfast as long as it is eaten at least two hours before the test begins. When the tests are scheduled for the afternoon, a full breakfast may be eaten.
EEG leads are placed on the head early in the morning and there is E.E.G. recording throughout the tests. The tests are done in the angiogram room of the Radiology Department , as you must first have an angiogram to show which areas of the brain will be affected by the sedative. A team of psychologists then establishes baselines on a variety of speech and memory tasks. The drug is injected and the test continues for about another half hour. The catheter is then withdrawn, and you return to your unit where you must remain in bed for at least 6 hours, keeping the leg in which the catheter was inserted, usually the right, straight. This is done to prevent any complications occurring.
Computed Tomography (C.T.)
A computed tomography (CT) scan is relatively simple, safe and completely painless examination that radiologists have performed for many years. The scan produces a series of images and can detect many conditions that do not show up on conventional x-rays. During some CT scans, a contrast medium (commonly called a dye) is used to outline blood vessels or fill up organs of the body so that they can be seen more easily. If you are allergic to iodine or iodine dye, please tell your physician. If your physician orders a CT scan with contrast, we will ask you not to eat or drink anything 3 hours before the test.
Positron Emission Tomography (PET)
In P.E.T. scans, very small quantities of substance which is normally used by your body are made radioactive and administered into your bloodstream. Radiation detectors measure the location of the radioactive substances. This enables your doctor to identify normal and abnormal functions within the brain. There are no side effects expected during or after the P.E.T. scan.
You might not need to have all these tests. Your doctor will advise you about which ones are necessary. Your cooperation is requested during your stay at the Montreal Neurological Hospital. Please let us know if you experience any change in the state of your health. We encourage you to consult another professional such as a social worker if you think you need to.
This information is for educational purposes only, and is not intended to replace the advice of a professional healthcare practitioner, or to substitute for medical care.
Parepared by 3 North Nursing Staff