Examination of seizures

In the general neurological practice epilepsy is considered to be a frequently occurring disorder which is in general easy to diagnose and can be treated very well with anticonvulsives. For the children and adults examined in Kempenhaeghe for diagnostics more information about the seizures is needed. As regards cause; as regards qualification; because the treatment started is not adequate or because there are additional problems such as learning, behavioural and/or social-emotional problems. Both for children and adults Kempenhaeghe has modules for target groups in which the additional questions and the possible connection with epilepsy are the subject of examination.

The results of the diagnostics form the basis for advice of treatment and counselling. This advice includes (remaining) educational and/or professional options. Further steps in treatment and counselling can be made within or outside Kempenhaeghe.

Advanced EEG examination

The ‘Guidelines for the diagnosis and treatment of epilepsy’ of the Working group Guidelines Epilepsy of the Dutch Society of Neurology (NvN) – please see the revised second version, January 2006, 40 and 41 – state that “the diagnosis of epilepsy primarily is considered on the basis of a description of the seizure – the (hetero) anamnesis.

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The findings of the EEG examination may increase or decrease the probability of the diagnosis epileptic seizure. For the identification of an epilepsy syndrome an EEG examination is indispensable."

The diagnosis of epilepsy is only evidenced if in fact an epileptic seizure is recorded during the EEG registration (ictal EEG). This rarely happens during a routine EEG. This means that the diagnosis epilepsy may not be rejected on the basis of an EEG registration which is considered to be ‘normal’.

Kempenhaeghe mainly performs more specialist forms of EEG registration. These may be registrations of several hours to sometimes even days, while asleep and/or awake and whether or not combined with – simultaneously performed – other measurements and examinations. When possible, the examinations are ambulatory or for outpatients. Sometimes admission of one day or a couple of days may be required. In addition to the diagnosis of epilepsy, EEG registration is applied to study the effect of anticonvulsives; in the examination trajectory to the option of epilepsy surgery and to distinguish epileptic seizures from psychogenic non-epileptic seizures (PNEA).

Tesla MRI

The ‘Guidelines for the diagnosis and treatment of epilepsy’ of the Working group Guidelines Epilepsy (please see the revised second version, January 2006, 40-41) state that “for every patient with a first seizure or epilepsy imaging diagnostics are indicated except for specific situations.

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Possible exceptions are acute symptomatic seizures based on metabolic disorders, absences, juvenile myoclonic epilepsy and such easily recognisable idiopathic generalised epilepsies. For children with a first seizure it is possible to first wait a while.”

Kempenhaeghe has its own high-quality 3 Tesla MRI with facilities for EEG-fMRI and MRI under narcosis. This offers a full range of MRI examinations of the brain.

Forms of examination

Kempenhaeghe offers – mainly in-house – high-quality research facilities which may also be applied in combination. Examples of specialised examinations are:

Seizure registration with video monitoring

For this type of examination the patient stays in a monitoring roomwith a few fellow patients. it is some kind of living room, where the EEG – and possibly a polygraph – of the patient is continuously registered . At the same time video tapes are made to record the clinical manifestations of a seizure. The registration continues at night. The aim of the registration is to determine the diagnosis at first. Or forms part of the trajectory required to examine whether a patient is eligible for epilepsy surgery. Normally, the aim is to reduce the number of epileptic seizures but during the seizure registration the induce of seizures is aimed at. This is achieved by temporary reduction of the medication, sleep deprivation, a flash-light programme, breathing exercises or physical exertion. The duration of the seizure registration with video monitoring is determined during the examination and depends on the number of seizures occurring. Sometimes the patient is admitted one day or a few days before the seizure registration to start the required reduction of the medication.

More information can be provided by A. Colon, neurologist / clinical neurophysiologist (Heeze location); L. Wagner neurologist / clinical neurophysiologist (Oosterhout location).

EEG – Psychological Examination (EEG-PO)

The EEG-Psychological Examination (EEG-PO) combines an EEG registration with a psychological test examination. The test examination measures the interests, options, qualities and skills of a child. The test examination is recorded on video. This combined with a simultaneous EEG registration provides an accurate image of the effect of the epilepsy on the child’s functioning. It is also possible to examine whether certain deficiencies in the functioning were caused by epilepsy or not. The examination usually takes a half-day and can be performed on outpatients.

Seizure detection

When regular clinical neurophysiological examination and observation prove to be inadequate to gain insight into the number and the nature of the epileptic seizures, seizure detection may be the answer. Seizure detection can be considered for patients with a serious seizure condition and additional morbidity such as mental retardation. Furthermore, there is the suspicion that the patient has more seizures (also at night) than the observed ones. Seizure detection is meant to gain more insight into the type of seizure and to optimise the treatment and/or guarding of the patient.

During a five-day admission several measurements will be performed such as an (ambulatory) EEG examination, movement measurement, heartbeat detection, video observation and detection of movement or fluids.

Kempenhaeghe offers for the time being, as an exception and depending on the required measurements, seizure detection on an extramural basis.

More information can be provided by Dr J. Arends, neurologist / clinical neurophysiologist.

Event detection

Event detection is meant to gain more insight into the circumstances of the nightly seizures or seizures which are difficult to observe with the naked eye and into the impact of these seizures. This should lead to a better recognition of and insight into (life-threatening) complications of seizures. Event detection is not useful if the frequency of seizures is low.

During an admission of one to three weeks for instance video observation, movement measurement, heartbeat detection and oxygen saturation are performed.

More information can be provided by Dr J. Arends, neurologist / clinical neurophysiologist.

MEG

MEG means magneto-encephalogram and registers brain activity through magnetic waves. As such MEG is more precise than an EEG (Electro-Encephalogram). The MEG measurement is performed in a special shielded room. The MEG equipment is a ‘large helmet’ containing the sensors which pick up the magnetic signals from the active brain cells. Often it is not even necessary to make contact between the head and the measurement equipment. Currently application of MEG registration is mostly limited to scientific research. Kempenhaeghe aims to have the MEG registration included in the routine care.

Structural MRI

In Kempenhaeghe structural MRI is aimed at making images of the anatomic structure of the brains. Structural MRI attributes to detection of possible causal factor(s) of epilepsy. Deviations or changes therein may be the cause (or the result) of the epilepsy.