Neurology

UNM Comprehensive Epilepsy Center
A cooperative program of the UNM Departments of Neurology, Neurosurgery, and Neuroscience

Bruce Fisch, MD
Medical Director

Academic Office
Department of Neurology
MSC10 5620
Health Sciences Center
1 University of New Mexico
Albuquerque, NM 87131-0001

Administrative Office
Phone: (505) 272-3342
Fax: (505) 272-6692
Neurology@salud.unm.edu

Diagnostic Testing and Indications

EEG: A 2 hour test of brain electrical activity performed to help diagnose and classify seizure disorders and in some cases determine the response to treatment.

Epilepsy Inpatient video and EEG Monitoring: A typically 3 to 5 day stay in the hospital during which brain electrical activity and behavior during attacks are recorded to help confirm the presence of a seizure disorder (vs a disorder that appears to be due to seizures), classify the patient’s seizure disorder so that the optimum treatment can be selected, and in some cases, to evaluate the patient for non-medical treatments such as curative epilepsy surgery or partial treatment of seizures using Vagus Nerve Stimulation.

The UNM Epilepsy Monitoring Unit is a state of the art facility with private patient rooms, each with an extra bed for family members, parents, or friends who the patient may like to stay with them. The Monitoring Unit nursing station is staffed by a dedicated nurse and a technician with 24/7 remote viewing of the patient video and EEG. At the time of seizures, the nurse performs an examination to help locate where in the brain the seizure comes from. This information is used in combination with the recorded EEG by the Center epilepsy physician.

Invasive Epilepsy Monitoring and Functional Mapping: A surgical procedure in which specialized EEG electrodes are placed on or in the brain to locate a site of seizure onset that can be safely removed to cure epilepsy and to allow for mapping brain functions to improve the safe removal of abnormal epileptic brain tissue. As in Epilepsy Inpatient video and EEG Monitoring (see above), once the electrodes are in place, the patient’s seizures are recorded. At the end of recording the electrodes are removed.

Genetic Testing: A blood test for the diagnosis of inherited seizure disorders or those due to genetic abnormalities. An increasing number of seizure disorders that had previously had no apparent cause are being revealed to be defects in nerve cell functions controlled by genes. These disorders may or may not be inherited.

Biological Screening: Blood tests for medical disorders (for example, abnormalities of the immune system, blood levels of sodium, calcium or magnesium, hormonal disorders, liver disorders or other medical conditions that can cause seizures).

3 Tesla MRI: A 1 to 2 hour test that provides a picture of the brain based on the magnetic activity of brain molecules. 3 Tesla is the strongest medically approved (FDA approved) MRI available. It provides more detailed anatomy of the brain and improved diagnosis of brain abnormalities that can cause seizures compared to other MRI’s in the state of New Mexico. The MRI at UNM is also performed in a special way (MRI epilepsy protocol sequences) for patients who are being evaluated for a seizure disorder.

MEG: A 4 to 5 hour test that measures brain magnetic activity. MEG is not a widely available test in the United States but it has been shown to provide more accurate determination of the area of the brain that is involved in epilepsy than EEG or other tests. It also shows where various areas are located in the brain that control language, movement, and feeling in the hands, feet and face. It is useful for planning for possible epilepsy surgery and for planning surgeries to remove abnormal brain areas such as vascular malformations (e.g., cavernous malformations, arteriovenous malformations) or tumors. The MEG instrument used by UNM is the most up to date system available in the world.

PET: A 3 hour test that provides a picture of brain cell activity (PET stands for positron emission tomography). Between seizures the part of the brain where the patient’s seizures come from often appears as an area of reduced brain cell activity. This helps guide medical treatment and especially possible surgical planning.

Wada Testing: an in hospital test that does not require an overnight stay that is performed as part of a presurgical evaluation to determine if it is safe to perform epilepsy surgery. The Wada test involves a cerebral angiogram during which memory and language testing is performed. The test requires the insertion of a catheter (small tube) into an artery (femoral artery) at the top of the right leg. After the procedure it is generally recommended that the patient remain in bed for 4 to 6 hours before going home.

Neuropsychological Testing: a clinic test lasting approximately 4 hours in which the patient’s memory and thinking is tested. This provides information about cognitive ability and what part or parts of the brain may be affected by epilepsy. It is routinely performed prior to epilepsy surgery.