Universitätsklinik für Kinder- und Jugendheilkunde
Pädiatrisches Epilepsiezentrum Wien
Epilepsy Monitoring Unit - EEG und EP Labor -
Ambulanz für erweiterte Epilepsiediagnostik
 

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Epilepsy Monitoring Unit

Telefon: +43 1 40400 38050

Mitarbeiter

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Allgemeines Krankenhaus der Stadt Wien,
Währinger Gürtel 18-20
Universitätsklinik für Kinder- und Jugendheilkunde
Ebene 9.

Lageplan


Description

The reason for monitoring is usually to identify and localize the epileptogenic zone in order to evaluate the possibility of epilepsy surgery.Other patients eligible for non-invasive intensive monitoring are

  • children with suspected pseudoseizures,
  • children with frequent polymorphic seizures in order to document the various seizure types and
  • children with episodic behavioural disturbances and abundant epileptiform activity in routine EEGs.

The purpose of intensive monitoring is to record clinical seizures in order to eveluate any possible relationship with electroencephalographic seizure patterns.

In children with very frequent clinical seizures only a few hours of monitoring might be sufficient. In most cases the monitoring is extended to several days, sometimes as long as two weeks. Reduction or discontinuation of current antiepileptic drugs (AEDs) is often necessary.

Presurgical evaluation:

First preoperative phase (Phase I):

  • Suffers the child from epileptic seizures that are otherwise intractable, (especially refractory to AED treatment)?
    Re-evaluation of diagnosis and seizure/syndrome classification, therapeutic re-evaluation (review of drug treatment hithero given, including compliance).
  • Are there subjective handicap and social disability and/or deteriorating development?
    Evaluation of psychosocial problems (covering aspects of cognitive and intellectual functioning, emotional problems and reactions as well as interpersonal interaction and social situations).
  • Is there any detectable etiology, i.e. organic brain lesion and/or an area of dysfunction?
    metabolic screening, CCT and high-resolution MRI
    clinical neurological examination,
    neuropsychological testing,
    decreased blood flow revealed by functional neuroimaging, e.g. interictal HMPAO-SPECT .
  • Is there a localizable seizure-producing brain area?
    Recording of a sufficient number of representative seizures, with combined Video/EEG-monitoring from extracranial electrodes, including sphenoidal ones. Increased blood flow (peri-)ictal HMPAO-SPECT.
  • Are there sufficient mental health, resources, tolerance?
    evaluation by psychiatrist, psychologist and other health personnel

A considerable number of children regarded as having intractable epilepsy are not considered refractory sensu stricto and benefit significantly from a systematic, comprehensive diagnostic and therapeutic re-evaluation program which also takes into account psychosocial aspects.

In the case that the results of all investigations of phase I are congruent, the patient enters phase II

 

Second preoperative phase (Phase II)

  • Testing of hemispheric dominance for speech, memory, musicality, initiation and control of motor and behavioural activities using neuropsychological tests, perception tests and WADA tests (in children>8years of age).

In the case that the identification and delineation of the epileptogenic zone is not possible with surface EEG the pre-surgical work-up is continued with (semi-)invasive recordings

 

Third preoperative phase (Phase III)

intracranial recordings see Department of Neurosurgery

 

Postoperative evaluation phase

This phase starts at the epilepsy centre about two/three days after the operation

EEG and clinical follow-up take place 1 week, 3 months, 6months, 1year, 2 years postoperatively, neuropsychological assessment at 6months and two years.

Drug regimen: AEDs are maintained for at least one year and then discontinued, provided the child has remained completely seizure-free.


Copyright (c) 2005 - 2014 Team Epilepsiemonitoring MedUniWien. All rights reserved.
Impressum/Medieninhaber: Univ. Prof. Dr. Martha Feucht, Universitätsklinik für Kinder- und Jugendheilkunde, Währingergürtel 18-20, 1090 Wien
Phone:
+43 1 40400 38050; email: martha.feucht@meduniwien.ac.at
Letzte Änderung am 22.04.2014 von Franz Benninger