Making the diagnosis
An adequate treatment requires a correct diagnosis, or in other words a thorough analysis of the epilepsy: what exactly is the problem and what is its causes? It is important to listen to what the patient tells, but it is equally important to hear the story of the spectator because the patient is often unable to observe what is happening during a seizure. You will help the neurologist by extensively describing the seizure or by showing a (self made) video recording of it.
Kempenhaeghe has a wide variety of diagnostic methods at its disposal to find out if epilepsy is present and if so, what type of epilepsy and the location of the epileptic focus. The neurologist will discuss with you what test method or combination of tests methods suits you best. Parents are allowed to stay with their children during the tests.
Epilepsy examination methods
EEG recording
The most important and used examination method is the EEG recording. EEG means ElectroEncephaloGraphy. Several small electrodes are attached to your body (your head, but sometimes other body parts as well). The electrodes measure the electric activity of your brain and abnormal patterns are thus identified. The examination is not painful, maybe just slightly annoying.
There are various forms of EEG recordings with differences in the time they take. Some examinations are done in daytime, other ones at night. Perhaps you will have to stay awake for a night. Some EEG recordings take several days and/or video recordings may be made. For some tests you will have to stay at Kempenhaeghe. So-called "ambulatory" tests allow you to go home once the electrodes have been attached. You will return the next day to have the electrodes removed again. It is important to keep a diary of your activities during such examinations.
The MEG recording is a special form of brain activity recording. MEG records the magnetic waves in your brain.
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Nursing observation
Nurses will observe patients during their stay at Kempenhaeghe to:
- Get an insight in factors influencing the epilepsy
- Get an insight in the way epileptic symptoms are presented
- Find out more about a person's behaviour or the way he/she maintains contact with other people
It may be necessary to take video recordings at night to observe epileptic symptoms during sleep.
Seizure recording
The objective of seizure recording is to capture one or more seizures as precise as possible. This type of examination necessitates induction of one or more seizures. The doctor needs to see precisely what happens in the brain during a seizure and with what "external" symptoms it is accompanied. This information will allow him/her to make a diagnosis.
Seizure recording always consists of a combination of EEG recording and video monitoring. The video recording shows what happens to a person during a seizure. If a seizure recording is to be made, you will have to stay at Kempenhaeghe for a few days. One parent can stay if the recording concerns a child.
To induce seizures it may be necessary for you to use less or no medication temporarily. Sometimes, it is necessary to stay awake for a night. You will stay at the so-called "monitoring room" during the seizure recording (possibly together with one or two fellow-patients). It is a kind of living room where your EEG will be recorded and video recordings will be made continuously. Unfortunately, your freedom of movement will be limited as you will have to stay within the range of the video camera. A TV set and video/DVD recorder are available though and you can bring something to read or games yourself to pass the time. You will have your own bedroom at night where you will be recorded as well.
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Neuropsychological examination
A neuropsychological examination will be performed in cases of e.g.
- Persistent cognitive complaints, such as problems with attention, memory, orientation and language usage
- Changes at functional levels, such as problems at school or mood disorders
(Neuro)psychological examination includes e.g. answering questions, performing tasks, measurement of response rate, and memory and reading tests. A psychology assistant will do the tests, but a psychologist will discuss the results with you.
Running the EEG and video recordings along with the psychological tests allows for a highly precise picture of the effect of virtually invisible epileptic seizures on a person's functioning. It also possible to determine if sudden loss of concentration and/or memory, dreamy behaviour and the like are caused by epilepsy.
Neuropsychological examination plays an important part in epilepsy surgery as well. Tests make it possible to determine in detail if an operation carries risks concerning language and memory, and if so, what risks.
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Blood tests
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MRI
MRI produces very sharp images of the brain. MRI is the abbreviation of "Magnetic Resonance Imaging". MRI scans are made at the Heeze location of Kempenhaeghe. MRI is painless and does not need special preparations. Metal containing objects and magnetic strip cards are not allowed in the MRI room. Thus, you should inform the doctor beforehand if you have metal objects (e.g. pins used in surgery or implanted medical devices) in your body.
Lying on an examination table with a plastic holder over your head you will slide into the so-called MRI tunnel. It is important to lay still! The MRI tunnel has a microphone for communication with the MRI assistant. You will be give a little ball to squeeze if you urgently need the MRI assistant. You will hear a knocking sound during scanning. You will be give ear plugs or a headphone to muffle it. One series of images is ready when the sound stops. Making one series of images may take thirty seconds to ten minutes. The full examination will take thirty minutes to one hour.
Patients unable to lay still (e.g. little children or mentally retarded people) can have MRI under general anaesthesia.
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Didactic examination
A didactic examination is performed at Kempenhaeghe if epilepsy is suspected to affect a child's learning at school. This examination may consist of:
- Talks with a specialized educational scientist
- (Re)evaluation of performed didactic examinations and tests
- Retesting
