Electroencephalogram (EEG)

EEG is a test which records the electrical activity of the brain. It is the ‘gold standard’ for the diagnosis of epilepsy.

Electromyography (EMG)/Nerve Conduction (NCS)

Nerve Conduction Studies and electromyography evaluate the integrity of the nervous system and are an essential component of a neurological exam when sensation or motor pathways are impaired.

Evoked potentials (EP)

Evoked potential testing utilizes various sensory stimuli to evoke a brain response that provide information about the integrity of various sensory pathways.

Transcranial doppler (TCD)

The TCD test evaluates the velocity of blood flow in the vessels of the brain using ultrasound waves. The test is used to monitor the progress of patients following subarachnoid hemorrhage, clipping and aneurisms or other cerebrovascular events.

Intraoperative monitoring (IOM)

Monitoring of the nervous system is needed for several procedures, both neurological and orthopaedic. During surgery to remove the focal part of the brain that is the major source of electrical disruption, an EEG is performed by recording directly on the brain. IOM is also used during orthopaedic procedures such as corrective scoliosis and selective posterior rhizotomy, and is used to monitor both sensory and motor nerves.

Video EEG Monitoring (VEEGM)

When medications are not effective in people with epilepsy (a condition known as refractory or intractable epilepsy), a higher level of diagnostic care and treatment is called for. In such cases, patients are admitted to the hospital for video EEG monitoring. 

During this procedure, patients are connected to EEG monitoring equipment. The equipment receives the EEG read-out, translates it to digital format and merges it with simultaneous digital video recording, allowing for a continuous record of seizures over several days.  A technologist monitors the recording, and an online computer monitors the EEG changes. Such monitoring allows the physician to diagnose the type, frequency, and precise location of patients' seizures. 

Epilepsy Surgery 

The Saskatchewan Epilepsy Program is part of a collaborative partnership including the Division of Neurosurgery and the Division of Neurology, working together to provide hope for adults and children with epilepsy in the province of Saskatchewan. 

In most patients, seizures can be adequately controlled with antiepileptic medications. However, in 40% of patients with seizure disorders, seizures are resistant to medical therapy. For some of these patients, surgery has the possibility of providing a complete cure of their epilepsy in some cases. Each patient under consideration for surgery participates in a thorough evaluation at the Royal University Hospital prior to surgery. 

The electroencephalograms (EEGs) of patient candidates are often recorded and analyzed in the Epilepsy Monitoring Laboratory, which helps to classify the type and the locations of the observed seizures. In addition, brain imaging studies including MRI scans, and SPECT scans may be used together. 

Patient specific conferences are held with the group for possible surgical candidates. All potential candidates are evaluated first by Dr. Tellez-Zenteno (adults) and Dr. Lowry (children).

Vagus Nerve Stimulation

Vagus nerve stimulation is a therapy for treating seizures that are resistant to conventional epilepsy medications. VNS involves placement of a small stimulator under the skin in the chest. The stimulator is attached to a small lead which is then attached to the vagus nerve in the neck. The stimulator provides a light electrical signal on and off throughout the day. In many patients, this causes a substantial improvement in seizure frequency and severity. 

Ketogenic Diet

For selected patients with difficult to control epilepsy, a ketogenic diet provides improved seizure control. Dr. Lowry, Dr Tellez and a registered dietitian work closely together to determine which patients might benefit from the diet, to educate the parents about the diet, and to help the parents initiate and manage the diet. Initial evaluation is through the Pediatric Neurology Clinic. 

Referrals to the dietitian come only from the pediatric and adults neurologists. After a referral, the parents meet the dietitian to discuss the specifics of the diet. After the diet is begun, usually in an inpatient setting, the dietitian and neurologists continue to work with the parents to maximize the benefit from the diet

Pharmacological Treatment 

Medication is widely used as the first step in treatment of epilepsy. Dr. Lowry and Dr. Tellez-Zenteno use their in-depth knowledge of the latest drug therapies available to treat patients depending on the type and frequency of the patients' seizures. This knowledge is essential in optimally treating patients with epilepsy, as eight new medications have been released in the past few years. 

Neuropsychological Testing

Neuropsychological testing measures a patient's memory and cognition. The most familiar example is the IQ test. Neuropsychological testing can sometimes help identify areas of the brain that are not functioning normally. Dysfunction may provide a clue as to the area of seizure onset. For example, impaired memory for word lists may indicate abnormal language dominant temporal lobe function.

Because one risk of epilepsy surgery is its effects on memory and cognition, baseline neuropsychological testing is an important component in pre-surgical evaluation. Neuropsychological testing for epilepsy surgery evaluation takes four hours. Neuropsychological testing is done by Dr. Mirna Vrbancic (www.medicine.usask.ca/psychiatry/people/part-time-faculty-consultants/vrbancic-m-1).

WADA Test 

WADA (intracarotid amobarbital) tests are performed at RUH to determine hemispheric language dominance and to determine whether a single hemisphere is capable of supporting memory. 

While commonly ordered as part of an epilepsy surgery investigation, WADA testing is occasionally obtained as a pre-operative planning tool in patients being evaluated for tumor or vascular anomaly resection. Wada testing is a complex activity that requires multiple individuals from different departments to work together as an integrated team.