Epilepsy is a neurologic condition which affects your nervous system. If you have more than one seizure not caused by a known medical condition, such as alcohol withdrawal or extremely low blood sugar, you’re considered to have epilepsy.
Seizures can sometimes be caused by a brain injury, or they can even be hereditary. However, in the majority of cases, the cause of epilepsy is unknown. Seizures are the primary symptom of epilepsy. A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. Epilepsy seizures can be mild and hardly noticed, while others can be totally disabling.
At the Comprehensive Epilepsy Center at Northwell Health Neuroscience Institute, we’re focused on providing you with the most advanced technology for seizure detection and treatment. Our integrated and multidisciplinary team of specialty-trained epilepsy neurologists, neurosurgeons, neuropsychologists, nurses and nurse practitioners, pharmacists, social workers, technical staff and administrative specialists all work together to provide you with personalized care. It’s our mission at the Comprehensive Epilepsy Center to provide you with seizure freedom so you can enjoy the most active, productive and fulfilling life.
Award-winning epilepsy care
North Shore University Hospital and Lenox Hill Hospital have been recognized as a Level 4 Epilepsy Center, the highest rating by the National Association of Epilepsy Centers (NAEC). Level 4 centers provide complex and intensive neurodiagnostic monitoring, in addition to extensive medical, neuropsychological and psychosocial treatment options. Fourth-level centers also offer comprehensive evaluations for epilepsy and a broad range of surgical procedures to treat the condition.
Staten Island University Hospital and Southside Hospital have been recognized as Level 3 Epilepsy Centers, the second highest rating by the National Association of Epilepsy Centers (NAEC). Level 3 centers provide a basic range of medical, neuropsychological, and psychosocial services needed to treat patients with refractory epilepsy. Third-level centers can offer noninvasive evaluation for epilepsy surgery, straight-forward resective epilepsy surgery and implantation of the vagus nerve stimulator. Third-level centers do not perform intracranial evaluations or other more complex epilepsy surgery.
- Diagnosis of seizures/epilepsy
- Unexplained falls or loss of consciousness
- Spells, transient events or neurologic symptoms or dysfunction:
- Language difficulty
- Sensory disturbance (numbness/tingling)
- Management and withdrawal of anti-epileptic drugs (AEDs)
- Seizures related to brain tumors
- New patient visits
- Follow up visits
- Consultation visits
- Routine EEGs
- Sleep deprived EEGs
- Ambulatory EEG monitoring
- Intracranial EEG
- Inpatient video-EEG monitoring during medication changes, refractory epilepsy or for initial diagnosis and classification of epilepsy
- Intracarotid sodium amobarbital test (Wada Test)
- Presurgical epilepsy evaluations
- Consultations available from numerous specialties, including physical therapy, neuropsychology, psychiatry, cardiology, and neurosurgery
Advanced diagnosis and treatment
Our extensive diagnostic methods, designed to the determine nature, type, and severity of your condition, include:
- Clinical history and physical examination — An epileptologist (a neurologist with special training in epilepsy) gets a clear description of the events (epilepsy seizures), as well as past medical, family and social history. An examination will be performed to assess cognitive, motor and sensory function.
- CT scan — Radiation and computer technology create images of the brain. This test is often used when seizures first begin and may be useful in detecting underlying non-epilepsy problems such as bleeding, tumor, infection or problems with the skull.
- Magnetic resonance imaging (MRI) — When looking for brain abnormalities that can’t be found with a CT scan, our epileptologists use one of the most advanced MRI units available to develop a highly detailed picture of the brain.
- Electroencephalogram (EEG) — An EEG records electrical activity from the brain. The EEG shows patterns of normal or abnormal brain electrical activity. EEG may help the physician to understand the part of the brain where seizures originate, the specific areas of abnormal brain tissue, the risk of further seizures and whether seizures may be occurring that the individual may or may not be aware of.
- Positron emission tomography (PET) — The PET procedure injects a small amount of radioactive sugar into a person to allow a radiation-detecting camera to record brain images. The pictures from Positron Emission Tomography show how and where the brain uses energy. Epilepsy can cause changes in the way the brain uses sugar, and a PET scan can help pinpoint a seizure focus.
- Single photon emission computed tomography (SPECT) — The SPECT procedure measures blood flow in the brain. An ictal SPECT scan is a study performed on people with very frequent or predictable epilepsy seizures. “Ictal” means that the scan is performed during a seizure. This test is performed by injecting a radioactive substance immediately after a seizure begins. After the substance travels to the area of the brain where seizures originate, a special camera detects its location in the brain and produces a corresponding image.
- Magneto-encephalography (MEG) — MEG is a test that records brain activity by evaluating magnetic fields generated by the brain, and may be an adjunctive test to EEG. MEG is usually used in only certain cases.
- Neuropsychological evaluation — A neuropsychologist conducts a number of tests to understand how well a person performs in different cognitive functions, such as memory, language, and attention.
- Intracarotid sodium amobarbital test (Wada test) — Sometimes a Wada test is necessary prior to brain surgery. This test is performed by injecting a drug via a catheter to temporarily put one side of the brain to sleep in order to test the function of the other side that is still awake. This allows a neuropsychologist, working with a neuroradiologist, to test functions of the right and left sides of the brain individually. The Wada test can determine how each side of the brain performs important brain functions like language and memory. This test also helps to determine the safety of undergoing epilepsy brain surgery.
- Intracranial EEG — In special circumstances, where appropriate for individuals with epilepsy that is highly resistant to medications, inpatient intracranial EEG monitoring may be done to pinpoint the location where seizures begin. For this type of EEG, small electrodes are placed under the skull by a neurosurgeon. The electrodes may be used to both record electrical signals from the brain and stimulate the brain in order to map necessary brain function. Performing intracranial EEG requires a dedicated center with a highly specialized team of neurosurgeons, neurologists, nurses, technicians, and staff.
- Video electroencephalogram (video EEG) —Video EEG is a key diagnostic test that records brain waves while a person is videotaped for a period of time. Video EEG is also helpful in monitoring the effects of anticonvulsant medications, and in evaluating for subclinical or subtle events of concern for epilepsy seizures. This painless exam involves placing electrodes on the head with gauze and a special cream, which will harden after application to help prevent the electrodes from falling off. A device will then continuously record patients' brain wave activity from the electrodes and behavior on video.
Video EEG results can help the epileptologist:
- Classify the event type
- Confirm the diagnosis of epilepsy
- Identify the type of epilepsy syndrome the person may have
- localize the seizure-related activity
- Design a treatment plan
The video EEG study usually takes between one to seven days but depends on the specific goals of the admission and the individual’s circumstance. The epileptologist will determine, based on the patient’s goals, when it is most appropriate to be discharged.
Both Lenox Hill Hospital and North Shore University Hospital have four-bed, state-of-the-art epilepsy monitoring units (EMU) staffed by 24/7 dedicated observation personnel, including epilepsy-trained doctors, nurses, neuropsychologists and a team of compassionate, certified video electroencephalogram (EEG) technologists. The EMU enables our staff at the Comprehensive Epilepsy Center to offer the most advanced and safest treatments for epilepsy, using both medications and minimally invasive approaches to epilepsy surgery.
We offer a variety of medical and surgical treatment options to control and prevent your seizures. If surgery is recommended, our multidisciplinary team provides the most innovative surgical treatments including stereoelectroencephalography (SEEG), laser ablation, combined stereoelectroencephalography (SEEG) and laser ablation, vagus nerve stimulation (VNS), disconnection surgery and Gamma Knife®. We perform between 50 and 100 epilepsy surgeries each year, and 90 percent of our patients are either seizure-free or have reduced seizures one year after surgery.