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Epilepsy Center
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Your Evaluation

How can I be evaluated at UCSF?

Our clinical nurse specialist, Maritza Lopez, RN, BSN, can be reached at 415-353-2134 and would be happy to help you. All new referrals for surgery are fully reviewed so that if you have had prior workup at an outside facility some tests may not need to be repeated. Give us a call today to arrange an evaluation.
Your primary care provider or neurologist can easily make a referral to UCSF- please see our information for providers.


The Pre-surgical Evaluation

The pre-surgical evaluation at UCSF is tailored to each individual patient’s needs and may incorporate visits to clinic, admission to our epilepsy monitoring, and any of the procedures listed below. Many patients have already had extensive testing and evaluation before they come to UCSF and we are happy to incorporate the results of these so that tests are not needlessly repeated.


Initial Evaluation

Ambulatory Care Clinic:

Many of our patients begin their evaluations in our beautiful clinic. During a first clinic visit to the UCSF Epilepsy center you will meet with one of our Epileptologists who will review your history and previous epilepsy care with you. During your first visit you and your epileptologist can make a plan for your evaluation at UCSF. We are always happy to work with your primary doctors and neurologists, and can contact them to discuss your care after your visit.

Epilepsy Monitoring Unit:

Your UCSF Epileptologist or primary neurologist may recommend that you come to our Epilepsy Monitoring Unit (EMU) for video-EEG monitoring. Our EMU is located on the 8th floor of our main hospital and is a designated suite of rooms with specialized EEG and video monitoring equiptment. Patients generally stay between 3 to 5 days while we records their seizures on video monitor and EEG. This admission helps us to determine a patient’s type of epilepsy and whether there is a single (focal) origin of seizures.


Advanced diagnostics

3T MRI with Epilepsy Protocol:

Magnetic resonance imaging (MRI) is a noninvasive imaging exam that uses a strong magnetic field in order to provide images of the brain or other organs. UCSF’s MRI has a very strong magnetic field (3 Tesla), which is especially well suited to the evaluation of epilepsy. Specifically, MRIexquisite and structureThe Epilepsy Center has worked closely with the Radiology department to develop specialized imaging sequences that provide the visual detail necessary to identify even the most subtle abnormalities. These type of findings are critical to help our epileptologist and surgeons determine whether there is a visible area of brain abnormality (lesion), which may be the source of your seizures.

Please Visit the UCSF Radiology Site for more on MRI
http://www.radiology.ucsf.edu/patient-care/services/mri


PET:

Positron emission tomography (PET) is a type of medical imaging that can measure and creates a visual map of the brain’s metabolism and other molecular functions. Most commonly, PET is used in patients with epilepsy to help determine whether there are areas of the brain that have abnormally decreased metabolism. Such defects in function are often associated with brain tissue related to seizure generation.
At UCSF, PET technology is combined with computed tomography (CT), in order to increase diagnostic accuracy. These studies can also be combined with high resolution MRI, resulting in a more comprehensive picture of brain structure and function. Epilepsy center patients usually undergo PET imaging to help localize the source of seizures and to confirm findings from Video-EEG or MRI. PET can be particularly helpful in patients who do not have any definite abnormalities on MRI.
(our own pics first).
Please Visit UCSF Radiology for more information on PET Scan:
http://www.radiology.ucsf.edu/patient-care/services/pet-ct

PET/MR

At UCSF there are tremendous opportunities to participate and benefit from the latest research. We are currently enrolling patients in a trial of a hybrid PET/MRI machine, one of the only such scanners and related study of focal epilepsy in the United States. PET/MR is a new multi-modal approach to imaging, which exploits simultaneous acquisition of high-resolution structural and functional brain information. While the scanner is still currently only used as a research tool we hope to be able to learn whether this type of imaging could be beneficial and used regularly for the evaluation of pre-surgical epilepsy patients in the future.
Links to PET/MRI Study info





SPECT:

Performing, advanced analysis, and interpretation of SPECT scans is a specialty of the UCSF Epilepsy center. SPECT stands for Single Photon Emissions Computerized Tomography, and is a brain scan that is done using a small amount of a radioactive compound injected intravenously at the onset of a seizure. The compound used is not harmful, but acts as a tracer, glowing brightly in areas of blood flow on scanner images that reflect the brain’s activity at the time of injection. The advanced analysis involves digital matching and subtraction of an image acquired when the patient is not having a seizure from that when she/he is having a seizure. The difference in the pair of scans is statistically compared against normal differences and then mapped on to the patient’s own MRI. These scans are a challenge to obtain and analyze but when completed can provide a remarkable “snapshot” of brain activity related specifically to the location of seizure related activity. They are usually reserved for patients with very frequent seizures and in whom other studies are not conclusively localizing.





For more information on Nuclear Medicine please go to the UCSF radiology website:
http://www.radiology.ucsf.edu/patient-care/services/nuclear-medicine


MEG/MSI:

Magnetoecephalography (MEG), also called magnetic source imaging (MSI) is a highly technological tool used to measure the magnetic field activity of the brain. In the same way that EEG measures the electrical fields generated by brain activity, MEG measures the magnetic forces. A MEG/MSI scan is a relative short scan (1-2 hours) that can be done both during a mild seizure or when the patient’s brain is at rest. The scan provides linear waveform images similar to EEG that are used to pinpoint magnetic fields in the brain that appear abnormal and are indicative of epilepsy. The scan is used for epilepsy patients undergoing pre-surgical evaluation to help localize the regions of brain that are the producing magnetic currents that we associate with epilepsy and seizure activity. Specialized computer modeling, tailored to epilepsy patients, is used to determine the source of the magnetic currents and localize the epileptiform activity.
MEG/MSI is available at only a few institutions in California, and UCSF is proud to have one the premier MEG laboratories in the United States. Robert Knowlton, MD, MSPH is an expert in the use and analysis of MEG in the care of epilepsy patients. As with SPECT imaging, MEG is often used for patient’s whose cases are not clear cut, for many patients without clear findings on MRI, MEG may help to localize seizures.


For more information on MEG, or how to prepare for your test, please visit UCSF radiology:
http://www.radiology.ucsf.edu/patient-care/services/diagnostic-imaging/msi-meg



UCSF Image Synthesis: the multi-modal approach

The UCSF Epilepsy Center excels at pre-surgical evaluation of epilepsy imaging not only because of our advanced diagnostic testing, but because our physicians are experienced in both the art and science of evaluating diagnostic images. We routinely use complex computer modeling to combine images from different sources to help create visually detailed maps of the brain where the electrical activity (EEG), magnetic field (MEG), metabolic activity (PET), blood flow (SPECT) and detailed brain structure (MRI) can be seen in a single image or series of images. Evaluating patients with this approach allows for the most sophisticated and accurate localization of the seizure source.


Neuro-Psychology evaluation

In addition to video eeg and diagnostic imaging, neuro-psychology testing is used to help us determine if your seizure disorder has created recognizeable cognitive patterns that may help us to understand both where your seizures originate from, and how surgery may affect you. Most surgical candidates will have an appointment with our neuropsychologist before surgery. During this appointment our expert will guide you through a series of mental exercises, that will provide out team with information about your functional skills such as language, memory and comprehension. The testing is non-judgemental and done in a comfortable welcoming environment by a neuropsychologist who specializes in epilepsy.


The Surgical conference: “ Bringing it all together”

During our biweekly surgery conference we discuss individual cases with all members of our epilepsy specialists, our neurosurgeons, neuropsychologists, advanced practice nurses, epilepsy MFT and surgery coordination staff. Each patient is presented individually and all aspects of their evaluation and care are taken into consideration. For each patient a plan is created for surgery (if indicated and desired by the patient) or other options for ongoing care and evaluation, including opportunities to participate in research studies. After the presentation of your case in conference you will be contacted by your doctor, or our epilepsy nurse specialist, to discuss the plan, and to schedule your upcoming appointments.


The Next Steps

All potential surgery candidates are discussed in our monthly interdisciplinary surgical case conference. Individual cases are discussed with all members of our epileptology team, our neurosurgeon, neuropsychologist, advanced practice nurses, epilepsy MFT and surgery coordination staff. Each patient is presented to the group and all aspects of their care and evaluation are taken into consideration. For each patient, a plan is created for surgery or ongoing care and evaluation. After the presentation of your case in conference you will be contacted by your doctor or our epilepsy nurse to discuss the plan, and to schedule your upcoming appointments.

 
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