Florida Comprehensive Epilepsy and Seizure Disorder Center

The North American Anti-epileptic Drug Registry is a centralized resource for patients and providers. It is run from Massachusetts General Hospital and is a source of information and support for pregnant patients who take ant-epilepstic drugs. It also collects data - you can register and data that you submit will be completely confidential. There are very strict guidelines for keeping research data confidential. If you are pregnant, or intend to become pregnant it is worth looking at their site and considering becoming a participant

 

Medicare plans have open enrollment - it is worthwhile doing your homework before choosing to go with one of three options:

(1) Medicare alone. Part A only covers hospital costs and is usually free. Part B covers doctor bills and testing. This does not cover medications and you will have a 20% copay for physician costs. Part D covers medications and is NOT adminstered by Medicare but is managed by private insurance companies - you should make sure that you get this to avoid a penalty that will be applied forever. 

(2) Medicare plus a supplement plan. This will cover the copay and deductible of Medicare part A and B and sometimes covers part D and foreign travel (Medicare does not cover medical care outside the US, even though this is usually much cheaper). 

(3) Medicare Advantage. If you use one of these plans, you do NOT have Medicare as such - the insurer you pick will be paid by Medicare to administer your insurance. These plans have the benefit of simplicity (they often cover medications and possibly other things like glasses and hearing aids) but the disadvantage that you may be told which hospitals and doctors you can use. They are very profitable for the insurance companies concerned, so expect to be bombarded with sales offers. 

Before picking Medicare Advantage or part D plans, make sure that your medications (if any) are covered.

 

 

 

PREPARING FOR AN AMBULATORY EEG

Why do I need Ambulatory EEG Monitoring?

Epilepsy is a disease of the brain caused by abnormal electrical activity.  Ambulatory EEG monitoring enables your doctor to observe your EEG over a prolonged period of time.  Ambulatory monitoring can help diagnose your seizure type and provides important information regarding the best treatment for your seizures.

What will happen when I am set up for monitoring?

Placement of the EEG wires for monitoring

EEG wires will be attached to your head with a special glue so that the electrodes will stay attached for several days.  Sometimes, the electrodes can cause some itching to occur and you can take medication to help the itching.  Do not scratch your head with the electrodes in place.  Benadryl 25 mg to 50 mg can be used for itching.  This can be obtained over the counter at your local pharmacy.

Food

Please do not eat potato chips or other snack foods or chew gum, since this will interfere with the EEG - it generates a lot of “noise” on the graph which makes it impossible to detect anything else.

Clothing

You should wear comfortable clothing while your ambulatory EEG is being performed.  Sweat pants and a loose fitting top with buttons down the front are suggested.  Tight fitting sleeves and pull over tops will not be permitted.  Do not attempt to pull a shirt or other clothing over your head during the ambulatory EEG.  The electrodes may become dislodged and the quality of the recording will be affected.

What do I need to do before my test?
  • Assemble enough comfortable, appropriate clothes to wear.  Most patients wear street clothes or a sweat suit during the day and warm pajamas and socks at night.  Remember that the tops should button and be loose fitting.
  • Bathe and wash your hair well.  Do not leave any hair products in your hair and remove any braids or hair extensions.  This will facilitate comfortable placement of the electrodes

What is Ambulatory EEG Monitoring?

EEG is the abbreviation for electroencephalography.  The electroencephalograph is a machine that translates the electrical activity of the brain into a series of wavy lines (a graph) on a computer called the EEG record.

An EEG measures the electrical activity of the brain, sometimes referred to as brain waves.  This test is performed to see how the different parts of your brain function.  It records a graph of your brain waves.

Digital analysis is a procedure that can give additional information about any problems that may be found.

Analysis and examination of the data obtained allows your doctor to see one of the many ways that your brain functions.

EEG is not a treatment of any kind.  No electricity is transferred to your brain.  The EEG only detects activity in the brain.

If you have a seizure during the test, you should behave as you normally would during a seizure.  Family and friends should follow your usual first aid or emergency procedures.

It can tell us what may be causing your episodes and help with deciding the best treatment for you.

The doctor can see seizure activity as well as sleep stages during your EEG.

The ambulatory EEG is a very expensive (~$20,000) piece of equipment that allows us to monitor a 24 hour period of brain waves but allows you to continue with most of your daily activities.  Do not get it wet.  Do no allow the box to get hit or banged against other objects.  Do not attempt to adjust anything on the device and do not adjust the wires.  You will be held responsible for any damages.

At the end of each 24 hour period you will return to the EEG lab to have the information downloaded to the computer for analysis.

How does an Ambulatory EEG work?

Small, non-invasive metal cups called electrodes (usually 16 to 32 in number) are pasted on the scalp, after careful measurement by a trained technologist.  The paste or glue is to keep the electrodes firmly in place.  If the electrodes are moved, then the quality of the recording will be poor.  The electrodes pick up very small changes in brain electrical activity.  The activity is amplified and recorded on the computer.  It is then translated into a complicated graph. During this procedure, the EEG is recorded for a prolonged period,allowing you to have a comprehensive EEG at home. You will need to keep a diary with exact times to correlate behavior with events on the EEG. Do not forget to use the button to mark the time of your events.  This helps to determine the cause of any seizures.

How will I get my results?
After the technologist completes your study the doctor will review the study and discuss it with you at your next visit.  If there are issues regarding the EEG of immediate concern, the doctor will contact you for further testing or discuss the findings with you on the phone.  Do not ask the EEG technologist to interpret or explain your results.  The EEG technologist will contact the physician if your EEG shows something that may be of immediate concern. 
 

Video EEG Patient Information

What is Video EEG Monitoring?

During this procedure, the EEG is recorded for a prolonged period, accompanied by continuous closed-circuit video observation. The digitized EEG and recorded behavior are displayed simultaneously, allowing point-to-point correlations of recorded events and any accompanying electrographic changes.  This allows the determination of the cause of the seizures.

Why do I need Video EEG Monitoring?

Epilepsy is a disease of the brain caused by abnormal electrical activity.  Video EEG monitoring enables your doctor to observe your seizures and the EEG at the same time.  Video monitoring can help diagnose your seizure type and provides important information regarding the best treatment for your seizures.  Video monitoring is also used in the evaluation for epilepsy surgery.  In some patients, epilepsy can be helped or  even cured by surgery.

What will happen when I am admitted for monitoring?
Placement of the EEG wires for monitoring

EEG wires will be attached to your head with a special glue so that the electrodes will stay attached for several days.  Sometimes, the electrodes can cause some itching to occur and you will be provided with medication to help the itching.

Your room

You will be admitted to a private room with additional seating in the room for yourself and your guests.  A video camera with sound is running in the room 24 hours a day.  You will be able to go to the bathroom in privacy.  In some cases, there is a bed available for your guest, but at other times you may need to bring an air mattress or other cushion for their comfort.  In general, you will be confined to your room for the length of your stay.  Some facilities may have long cords or day rooms.  Some rooms have exercise equipment, video players or games, others do not.  You should ask about these facilities at the hospital where you are scheduled.

Food

If you are not on a special diet, friends and family members may bring outside food for you to eat.  You may not eat potato chips or other snack foods or chew gum, since this will interfere with the EEG.

Clothing

You should bring comfortable clothing to wear while on the video monitoring unit.  You will not be able to use covers even during sleep because this impedes the viewing of your seizures.  Socks, sweat pants and a loose fitting top with buttons down the front are suggested.  Tight fitting sleeves and pull over tops will not be permitted.

Bathroom Use

In most cases, patients will be allowed unrestricted bathroom privileges.  When you are at highest risk for seizures, someone will need to accompany you for safety purposes.  You will not be video taped while in the bathroom.

What do I need to do before my admission?
  • Sometimes you will need to stop your medications prior to admission.  Please contact the office the week before your admission for specific instructions.  Stopping medications will help you to have seizures more quickly.  The more seizures you have, the more likely it is that we will have a successful monitoring session, and it will at times allow you to go home sooner.
  • Get books to read or puzzles to do during the monitoring to keep you from getting bored or restless.
  • Plan to bring your laptop and charger.
  • You will not be allowed to smoke or chew gum during monitoring.  Plan for stopping smoking prior to the monitoring.  You can use nicotine patches during the monitoring.
  • Assemble enough comfortable, appropriate clothes to wear.  Most patients wear street clothes or a sweat suit during the day and warm pajamas and socks at night.  Remember that the tops should button and be loose fitting.
  • Get video tapes to watch during monitoring.
  • Bring a Game Boy or similar device to play especially if your seizures a brought on by playing the device.
  • Arrange for a friend or family member to be with you if at all possible.
  • Bathe and wash your hair well.  Do not leave any hair products in your hair and remove any braids or hair extensions.  This will facilitate comfortable placement of the electrodes.
Monitoring Comfort

Every effort is made to make your stay as pleasant and brief as possible.  Keep in mind that this procedure is to help you get better and obtain you best chance at freedom from seizures.  However, at best, it can be a boring and tedious process but we would like to see at least 3 episodes or more during your admission.

Risks of Monitoring

All medical procedures carry a certain amount of risk.  Although video monitoring is relatively safe, you could have an uncontrollable seizure, you may experience unusually severe seizures or you may be confronted with emotionally upsetting information.  If you are concerned, you should talk further with your doctor.

 

PREPARING FOR AN EEG

Where is the test done?

The test is usually done in Dr. Rodgers office. If you have any questions before the test, please call the office at 813-903-9200. Sometimes, we may schedule the test at University Community Hospital - the hospital next door to our office.

This test is often done on Saturdays so that the surroundings are quiet and for patient convenience. The building is locked and the EEG technician will let you in - please wait by the sliding glass doors next to the pharmacy on the hospital side of the building. As soon as the technician has finished the previous test they will come down to open the doors.

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