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Along with careful medical histories, we use the most advanced diagnostic tools available to make an accurate diagnosis and find the best possible treatment plan for our epilepsy patients.

Learn more about our diagnostic and treatment options.

Neurological Testing

We conduct standard neurologic tests, including:

Electroencephalography (EEG): EEG or "brain wave test" evaluates brain function and can pinpoint the location of seizures in the brain based on the presence or absence of abnormal brain waves. This is a short test lasting from 20 minutes to one hour. Often times this is the first screening test. We frequently use EEG paired with video in the hospital for extended periods to diagnose complex seizure disorders.

Ambulatory Electroencephalography: We also offer ambulatory EEG testing, in which the patient wears an EEG recorder that is slightly larger than a portable cassette player and collects up to 24 hours of brain activity while the patient goes through his or her regular daily activities, permitting examination of brain activity throughout the patient's day.

Video-EEG monitoring: This test has emerged as the "gold standard" for the diagnosis of complex seizure disorders. The procedure requires a stay in the hospital for up to one week. During video-EEG monitoring, the patient wears an EEG transmitter connected to a wall outlet by a cable. He or she can move about and carry out normal activities, such as talking, reading, and watching television. Ceiling-mounted video cameras continuously record the patient's behavior. The EEG and video signals are synchronized and displayed simultaneously for observation by a physician. Inpatient monitoring also allows for observation of the patient during a full night's sleep, increasing the possibility of recording epileptic activity and other nighttime events. Data generated by this test improves diagnostic certainty and can be very helpful in making treatment decisions, including the choice of the right antiseizure medication and candidacy for epilepsy surgery.

Magnetic resonance imaging: MRI uses radio waves and a magnetic field to create detailed images of specific parts of the body, including the brain and nerves. A brain MRI is a high-resolution study that can identify the smallest of structural abnormalities and provides much more detail than a screening CT scan.

Specialized Testing

In addition to these standard tests, the Weill Cornell Medicine Epilepsy Center offers more specialized testing that can further help define the seizure focus or provide insight into a patient's baseline cognitive or "thinking" function. These tests include:

Intracranial EEG monitoring: This test is helpful for patients who may benefit from epilepsy surgery. Through a small operation, EEG electrodes (called "intracranial monitoring devices") are placed on the surface lining the brain, or even deeper in the brain by expertly trained neurosurgeons. By having seizure-recording devices much closer to the source, the point where seizures begin can be very precisely located.

Neuropsychological testing: Epilepsy often affects memory and brain functioning. This test analyzes a patient's strengths and weaknesses in language, memory, concentration, as well as motor, visual-spatial, and other mental skills. Information gathered from this test can be helpful in determining a person's baseline mental functioning and is often used in conjunction with other testing to assess pre-surgical "mental fitness".

PET Scan: This type of specialty scanning uses a sugar or glucose intravenous tracer to create brain imaging. Often times the area of seizure onset will be less metabolically active and have a unique pattern on imaging. This type of testing is most often used in patients preparing for epilepsy surgery.

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Medication

The first and most common treatment option for epilepsy is medication. There are over 20 different epilepsy and anti-seizure medications available in the US.

Epilepsy specialists, such as those at the Weill Cornell Medicine Epilepsy Center, determine the best medications for you and your specific needs based on several factors. Your medical history, epilepsy type, and current medications will all be evaluated. Possible side effects from the medication will also be considered.

About two-thirds of patients achieve seizure freedom using medication alone. If medication is not enough to reduce and eliminate seizures, other options are available.

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Surgery

If a patient does not completely respond to traditional anti-seizure medications there are now several surgical options.

The most common form of epilepsy in adults is temporal lobe epilepsy. Both the right and left temporal lobes function together to help with both visual and verbal memory, among other functions. The brain tissue that gives rise to seizures often times is injured and not functioning properly. Removing injured tissue (resective surgery) particularly in the temporal lobe can lead to very high surgical success rates of 70 percent or greater. In order to precisely localize the brain area giving rise to seizures intracranial EEG monitoring may be needed with electrodes placed by the neurosurgeon.

Patients may also have improvements in overall mental functioning and quality of life with seizure reduction. For many patients, surgery can be curative from seizures. Patients may also be able to reduce or stop anti seizure medications if they remain seizure free.

Laser surgery is the latest generation of minimally invasive neurosurgery and is an advanced option for people who have certain kinds of epilepsy. This is an effective option, particularly for those at risk of serious complications in their daily lives due to continued, uncontrolled epilepsy.

During a laser procedure, the neurosurgeon creates a small opening in the skull and inserts a laser probe. Using MRI guidance, the surgeon delivers the laser through the applicator to remove the part of the brain causing the seizures.

It is very important to seek out a highly experienced care team, such as the specialists at Weill Cornell Medicine Epilepsy Center, when considering epilepsy surgery.

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Nerve Stimulation

VAGAL NERVE STIMULATION (VNS): VNS is an option for those who do not achieve seizure freedom with medication alone and is not a candidate for resective epilepsy surgery. A small device is inserted just beneath the skin below the collarbone. This device sends a small electrical pulse directly to a nerve on the left side of the neck called the vagus nerve. From the vagus nerve, the electrical pulse travels to the brain.

Patients can activate the device themselves when they feel a seizure coming on. The result typically is a less severe and shorter seizure, with less side effects once the seizure subsides. 

The benefits of VNS include:

  • VNS usually reduces the patient’s number of seizures by more than 50% and often fewer seizure medications are needed when on VNS,though it may take some months of VNS therapy to see the maximum effects
  • VNS is in the lowest risk category for pregnancy
  • VNS has no drug interactions and no sedative side effects

The most common side effects are deepening of the voice and hoarseness every few minutes during stimulation. The device battery lasts up to seven years, and a brief outpatient surgery is required then to replace the device.

RESPONSIVE NEUROSTIMULATOR (RNS): This relatively new treatment is often called “RNS” for “responsive neural stimulation.” Like VNS, RNS is indicated when medication alone is not able to control seizures and surgery is not an option. RNS is an electrical device that is implanted to detect abnormal brain activity that occurs before a seizure and respond with electrical stimulation to stop the seizure.

The device, the RNS® System from NeuroPace, works in two stages:

  • In the first stage, it records brain activity in the area of a patient’s brain where seizures are known to originate.
  • In the second stage, the device is programmed to detect abnormal electrical activity in that area and deliver mild stimulations to interrupt and prevent the seizure.

This implant may be a good option for those who suffer from disabling seizures (approximately 400,000 people in the US alone).

Drs. Steven Karceski and Theodore Schwartz at Weill Cornell Medicine were the first to implant RNS after it was approved by the FDA.

“For patients like ours, who have seizures that medication can’t control, this is a very promising new option,” Dr. Schwartz says. “Ever since I’ve been involved in the clinical trial, I have been confident that this would become a good option for patients. It feels great to have a procedure like this become available, and then see how it can give someone their life back.”

Watch Tracey's story about achieving seizure freedom with RNS

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