Inpatient Services

The inpatient facility provides intensive evaluation of children and adults with epilepsy. There are two main reasons that you may be referred. First is characterization of attacks – not all attacks thought to be epileptic seizures are due to epilepsy, and if attacks are due to epilepsy it can be very important to determine the exact type of seizures. The second reason is for determining suitability for surgical treatment of epilepsy. This is only considered if attacks are not controlled by medication.

How to be referred: Your doctor will need to send a referral to one of our neurologists, who will determine whether inpatient evaluation is necessary. If so, your information will be passed on to the Epilepsy Liaison Nurse who will arrange the appointments for you.

What’s involved

This will vary from patient to patient. We try to minimize the time in hospital so your tests will be streamlined by our staff and some may be organised for you as an outpatient. The information gathered is then discussed by a group of specialists to advise how best to treat your epilepsy.

Some of the tests and investigations that may be conducted while you are an inpatient are discussed below. More information is available by downloading the Patient Information Brochure.

Epilespy Investigations

EEG/VEM

Video EEG monitoring (VEM) records both your EEG and behaviour during a seizure . If you are being considered for epilepsy surgery the doctors need to know exactly what type of seizures you are having and where in your brain the seizures start. It is also sometimes difficult to distinguish seizures from some other types of events and VEM can help sort this out.

VEM is done while you are a patient at the hospital. At the start of your stay the EEG technicians will apply EEG electrodes to your head and you will be constantly connected to an EEG monitor and under video surveillance for your whole stay. The average stay is eight days. The room is set up with a video camera and computer which records information about movements and your brain function. The cameras are linked to three small monitors outside the room which are watched during the day by a member of nursing staff. This is to ensure we receive all available information as early as possible and also to ensure your safety during a seizure.

During the monitoring you need to stay in the room at all times except for going to the toilet. This means you need to bring enough with you to keep yourself occupied during your stay. For more information about what you can and cannot do during the monitoring please read the Patient Information Brochure.

Figure (1): EEG tracing

MRI (Magnetic Resonance Imaging)

An MRI scan produces clear pictures of the brain. It is used to identify any abnormalities in the brain which may be causing the seizures. The MRI machine uses magnetic fields and radio waves to produce the images. There are no x-rays or radiation involved. Because the machine uses magnets to take the pictures it is important to tell the radiology staff if you have any metal implants.

MRI scans take about one hour to complete. During this time you need to lie still on your back. You will lie on a narrow bed which moves into a tunnel in the scanner. Some people find this a bit unpleasant as there is not a lot of room, but the machine is well lit and ventilated and you will be given music to listen to.

We are constantly trying to gain more information from MRI. You may be asked to have a scan at the Brain Research Institute which has a more powerful instrument than that used routinely.

More information about MRI can be found at the Brain Research Institute website or the Royal Children's Hospital Epilepsy Program site.

Figure (2): MRI Scanner

SPECT and PET

SPECT and PET scans are types of brain scans that provide information about the function rather than the structure of your brain.

As part of investigating your epilepsy, we sometimes inject the drug Ceretec into your veins during a seizure. The drug travels in your blood to the part of the brain that is using the most oxygen, which is often the area generating the seizure. After this is injected you will have a scan to gather the information. Ceretec can only be injected between the hours of 9am and 5pm, as the scanner is closed out of hours.

PET scans use an injection of radioactive glucose to show the sugar metabolism in your brain. In some cases the site in the brain causing the seizures may be less active and so use less sugar between seizures. This scan can only be performed if you have not had a seizure for 24 hours. You are required to not eat or drink for 4 hours prior to the test.

More information about SPECT and PET can be found at the Austin Health Nuclear Medicine web site and the Positron Emission Tomography page of the Royal Children’s Hospital Children’s Epilepsy Program site.

Neuropsychology

There are two phases for neuropsychology assessment. The first assesses your memory, concentration, language and other thinking functions. This provides us with important information that can assist in the assessment of your seizures.

The second phase involves a detailed assessment of you and your family to assess psychological and social issues related to surgery. It is important to know how you and your family are feeling about surgery and what your expectations are. Should you have surgery, you will be followed up with a neuropsychologist after one month and again at 12 months for retesting.

The Comprehensive Epilepsy Program has established a wide-ranging pre- and post-operative support program for patients undergoing surgery. Our program has been internationally recognised, and provides a range of multidisciplinary services. These include specialist medical and neuropsychological reviews, and psychosocial counselling which are routinely provided at regular intervals after surgery. This is complemented by post-operative phone follow-up from specialist nursing staff and psychology graduates.

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