Advances in Epilepsy Diagnosis and Treatment Monitoring: Continuous EEG

Esmeralda Park, MD, and Abdul Mazin, MD

“At AMITA Health Neurosciences Institute and the Center for Pediatric Brain we are prepared to diagnose and effectively treat all pediatric seizure disorders. Our team uses latest neuroimaging technology to look for structural brain abnormalities, hydrocephalus or hemorrhage when evaluating pediatric patients who present with seizures.”

‒ Abdul Mazin, MD

At the AMITA Health Neurosciences Institute and the Center for Pediatric Brain, a multidisciplinary, experienced and highly trained team manages all aspects of pediatric and adult epilepsy care, from diagnosis to treatment, in both an inpatient setting and a dedicated outpatient Epilepsy Clinic. The team works closely with referring physicians to achieve the best care for their patients, sharing inpatient status updates and test results, discussing the initial treatment plan and answering questions about the treatment plan and any needed adjustments. Patients are evaluated by one of the experienced epilepsy specialists: Abdul Mazin, MD, Esmeralda Park, MD, Marvin Rossi, MD or Michael Smith, MD.

Patients who are referred to the AMITA Health Neurosciences Institute might be experiencing new-onset seizures or seeking a second or third opinion after an epilepsy diagnosis. Once referred, patients are assigned to a nurse who provides a consistent point of contact throughout diagnostic testing and treatment planning. Multiple diagnostic modalities are available, including baseline and continuous electroencephalography (EEG) and magnetic resonance imaging (MRI).

Benefits of Continuous EEG

Applied in an inpatient, intensive care setting, continuous EEG can identify seizures earlier, catch hard-to-detect, sub-clinical seizures, develop treatment plans that are tailored to each patient and monitor treatment response in real time.^1,2 The continuous EEG session runs for a 24- to 48-hour period, with minute-by-minute recordings that can be monitored by the physician from any location. Physicians can remotely check in with patients during the session to analyze EEG results. This technology has made it possible for the neurology team at the AMITA Health Neurosciences Institute to reach more accurate diagnoses and develop effective, individualized treatment plans.

Multidisciplinary Approach

The AMITA Health Neurosciences Institute offers all of the same epilepsy treatment options that are found in any tertiary center, including medication, ketogenic diet, device therapy and surgery to remove the seizure focus. The AMITA Health Neurosciences Institute also has an active clinical research program in epilepsy to provide patients with leading-edge options in diagnosis and treatment.

“While we aim to address the patient’s medical needs in terms of epilepsy diagnosis and treatment, we also consider all of the issues that can impact a patient’s quality of life — getting them back to work or school, and back to driving — by providing supportive care for the whole patient.”

‒ Esmeralda Park, MD

Our epilepsy care team consists of a neurologist, neuroradiologist, neuropsychiatrist and dietitian who together take a multidisciplinary approach to treatment planning and ongoing care. Medication is often the first-line therapy and is selected based on the type of epilepsy and any co-morbid conditions (e.g., mood disorders). Patients receive holistic, supportive care that addresses all of their needs and treatment goals — not only to reduce seizures, but also to address any other medical and psychosocial issues to improve the overall quality of life. While patients will move back into the care of their referring physician and take an active role in self-management, the AMITA Health epilepsy care team is always available for follow-up and ongoing support.

Pediatric Neurology at the AMITA Health Neurosciences Institute

Dr. Mazin and his colleagues are dedicated to providing timely diagnoses and compassionate, comprehensive care for children with epilepsy or who have underlying medical conditions that put them at high risk for seizure activity. Dr. Mazin’s team recognizes that epilepsy affects every part of a child’s life — going to school, spending time with friends or family, and everyday activities like riding a bike or swimming. The goal for Dr. Mazin’s team is to help patients — and their families — enjoy life with as few restrictions as possible.

Pediatric seizures can be caused by many factors — genetic, structural, and environmental — and the multidisciplinary pediatric care team at the AMITA Health Neurosciences Institute works together to identify those factors and plan a course of treatment. For each patient, the team combines neuroimaging information about brain structure and connectivity with the results of advanced genetic testing and neurocognitive, behavioral, metabolic and physical function assessments. Ambulatory EEG and video monitoring can also add valuable information to the diagnostic workup. Taken together, this information provides a holistic view of the seizure activity and its causes, which then helps the team identify the best course of action to reduce seizure activity.

“As much as I am helping my patients, they are also helping me. I feel so honored to be able to make a difference and watch my young patients go on to live full lives.”

‒ Abdul Mazin, MD

Treatment often starts with medication, which is matched to each patient to eliminate the specific type and cause of seizure activity while minimizing side effects. For some patients, surgery may be an option; Dr. Mazin works with pediatric neurosurgeon, Bryan Bertoglio, MD, and the radiology team to identify patients who have well-defined lesions that can be removed to reduce seizure activity. Other treatment options include vagal nerve stimulation or a ketogenic diet. All pediatric patients and their families also have access to speech, occupational and developmental therapy, nutrition guidance and neuropsychology services. Dr. Mazin and his team keep a direct line of communication open with referring pediatricians to keep them updated about the patient’s treatment plan and progress and to answer any questions.