There are several reasons your doctor may suggest that you be admitted to the hospital for continuous monitoring. Monitoring allows your doctor to see precisely how many seizures you are having. It can also tell your doctor which drugs might be best for you by determining exactly what type of epilepsy you have. If you are being considered for epilepsy surgery, monitoring is necessary to locate the area where your seizures begin.
Where will I be admitted?
There are two Epilepsy Monitoring Units at New York-Presbyterian Hospital, Columbia campus. Milstein hospital, located at 171 Fort Washington Avenue, is for adult patients and Morgan Stanley Children's Hospital of New York, located at 3959 Broadway (and West 166th Street), is for children.
All the electrodes are connected to a small box which is placed in a "fanny pack" or small backpack that you wear or carry. The box is attached by a long cable to the EEG monitoring equipment, which is located in your room.
How long will I be in the hospital?
We estimate seven days but, depending on how many seizures you have, it may be longer or shorter. How many seizures do I need to have? It all depends on the nature of your seizures and what we see on the EEG.
Can I get out of bed?
Yes. The cables are long enough that you are able to go to the bathroom, get out of bed to sit in a chair or move around your room. In order for us to capture all of your seizures on the EEG and video, we ask that you stay connected to the system and within camera range as much as possible.
What if I don't have seizures when I'm in the hospital?
Many patients have this concern. We may try to bring on seizures by reducing your medication slowly or by other means such as hyperventilation or sleep deprivation.
What should I do when I feel a seizure coming on?
You should press the system's alarm button (the technologists will show you where it is located). Once the seizure is over, write it down in the seizure log book. If you don't get a warning and believe that you have had a seizure, press the alarm button anyway to call the nurse so that he/she can test your language abilities and memory to make sure that you have recovered fully.
What should I do if some of the electrodes come off?
Call the nurse so she can notify the EEG technologist.
What other testing will I have while in the hospital?
If you have not already had one, you will have an MRI. Sometimes a SPECT scan will be done. You may also be seen by an epilepsy psychiatrist. At another time- either before or after your admission for video-EEG monitoring, you will have neuropsychological testing.
The first year after surgery is a time when you may experience changes in your self perception, your level of independence, and your relationships with others. It is important to anticipate any issues that may arise with these changes after surgery so that your adjustment to your life after surgery goes as smoothly as possible.
Who will be my doctor in the hospital?
The epilepsy service works as a team. The doctor who saw you in the office will be your primary doctor but you will also see members of the epilepsy team. This includes other attending physicians who are specialists in epilepsy, as well as epilepsy fellows, neurology residents and medical students.
What should I bring with me to the hospital?
We encourage you to wear your regular clothes during the day and your pajamas at night. Clothes that button or zip down the front or back are best. The electrodes and wrappings on your head make "pull-on" shirts hard to put on. You may also want to bring books, puzzles, knitting or whatever hobbies you may have.
Some patients find that photographs or a special pillow or blanket make the room more comfortable. There is a VCR in your room so bring any videos you might like. Children are encouraged to bring a favorite toy or stuffed animal.
Can I smoke?
New York Presbyterian Hospital and Babies Hospital have no-smoking policies. If this is a problem, please let us know before admission. Nicotine patches are available.
Can I wash my hair?
No, not while you have the electrodes on. If you are in for an extended length of time we will take the electrodes off for a few hours to let your scalp rest. If this happens you may take a shower and wash your hair.
May I have visitors?
Yes. We encourage you to have visitors, except when you have tests scheduled. You may also speak on the telephone. If you like, we can often make arrangements to allow a family member to stay with you overnight, free of charge.
What happens once you find what you are looking for?
If you are here for a diagnosis, you will be discharged home on medication and return to your doctor's office for a follow-up visit or be seen by your referring physician. If you are here for an epilepsy surgery evaluation, a team conference will be held in the near future to review all of your hospital findings. The recommendations from the team conference will guide the epilepsy surgery or lead to further diagnostic testing.
The Wada Test
Why is a WADA test necessary?
Before having epilepsy surgery, it is very important to determine how language and memory are organized in your brain. This information is used in several ways:
- to help protect language and memory functioning after surgery,
- to help predict whether there might be problems in these areas after surgery,
- to provide additional information about where in the brain your seizures are coming from.
What happens during the WADA test? How long does it take?
The actual testing of each hemisphere takes only about 10-20 minutes, however, there is a lot of preparation for the Wada test. The full procedure takes approximately 2 hours.
From start to finish, this is what you will experience:
1. You will be admitted to the hospital at 7:30am. You will probably be taken directly to the radiology/angiography department rather than to your hospital room. You will change into a hospital gown, and electrodes will be placed on your scalp. (These will be very few compared to the number you had during your EEG monitoring). The nurse will place an IV in your arm, and a patch with an anesthetic gel will be placed in your groin area. The purpose of the patch is to numb the skin in this area, because this is where a catheter or tube will be inserted.
2. The neuropsychologist will do a "practice" Wada test with you so you will know exactly what to expect. The test is very easy (described below).
3. You will then be taken into the Angiography Suite, and an angiogram will be performed. The purpose of this is to look at the blood vessels in the brain to make sure that the anesthetic is going to the correct part of the brain. The anesthetic, also called "amytal" or "amobarbital" is what puts half of your brain to sleep for a few minutes.
How is the catheter placed in my brain? Does it hurt?
The catheter is inserted in the groin area and then threaded up through the body until it reaches one of the blood vessels in the neck that supply half the brain. The first thing to remember is that you will already have a patch to numb the area where the catheter is inserted. This will numb the skin in this area, however, you may still feel a "pinch" and will feel some pressure. A deeper anesthetic will also be given in the groin area to keep that area numb. This is the only part of the procedure that may hurt! You will not feel the catheter being threaded through your body up to your neck! When the catheter is in place, the radiologist will inject a dye that will show the pattern of blood vessels in your brain. You may feel some warmth in your face.
What are the memory and language tests like? What if I have bad memory?
Once the angiogram is performed, the actual test will begin. The neuropsychologist will ask you to count out loud and the radiologist will inject the amobarbital (although you will not feel this). This will put half of your brain to sleep for about 5-10 minutes. Even though half of your brain is "asleep," you will be awake! The neurologist and neuropsychologist will then ask you to perform simple tasks, such as naming pictures, repeating words and answering questions. You will be asked to try and remember some of the items. When the half of your brain that was asleep returns to normal (after about 10 minutes), the neuropsychologist will test to see if you remember the items you were asked to remember. If you do not remember offhand, you will be provided with multiple choice. There is no need to worry if you do not remember the items. Just try your best.
What will I feel during the test?
1. One of the first things you will feel is that half of your body becomes very weak. This is normal and only lasts a few minutes. It tells us that the amobarbital is working and that it is in the right place.
2. A few people feel some pain behind the eye when dye or amobarbital is injected. This only lasts a few seconds.
3. You may feel a little "giddy"; as if you have had a glass of wine. You may feel a little tired. You must try to stay alert if this happens!
4. You may have some difficulty speaking for a few minutes; this is normal! You may not be able to speak at all, or, you may sound like you are speaking gibberish, or, you may say the wrong words. For example, you may want to say "tree" and instead you say "house".
5. Some people shiver a little. This is not a seizure, and it only lasts for a few minutes.
How should I prepare for the WADA test?
You cannot eat or drink anything after midnight the night before the test. You should continue taking your medications as instructed with a small sip of water only. You should call your doctor if you have a seizure the day or night before the Wada test. If you are not fully back to normal, the test may have to be postponed.
Also, make sure your doctor knows if you have any allergies (especially to dyes or iodine) or heart problems.
What are the risks of the WADA procedure?
The risks are usually minimal. However, you should discuss your particular situation with your doctor. In general there is a very small chance of stroke and a very small chance that a clot will form in your leg alter the procedure. There is also a risk of an allergic reaction to the dye. You should notify your doctor if you have had a previous allergy to dyes injected into your body during other tests such as CAT scans or intravenous pyelograms.
What happens after the WADA test?
You may eat as soon as you return to your room. You will need to lie in bed with your right leg straight for six hours. You will need to use urinals or bedpans during this time. Keeping your right leg straight prevents bleeding from the area where the catheter was inserted and makes the small chance of clot formation in your right leg even smaller. Nurses will check the pulses in your right foot from time to time. Your doctor will discuss the results of the test with you. Usually you will need to stay in the hospital overnight and be discharged home in the morning.