The Comprehensive Epilepsy Program utilizes the most advanced diagnostic technology to classify and determine the cause of the seizure or epilepsy.

Bayfront offers:

·        Digital, long-term, video-EEG monitoring and a dedicated in-hospital unit for around-the-clock evaluation

 

·        Epilepsy protocol high-resolution MRI (magnetic resonance imaging)

 

·        24-hour ambulatory EEG monitoring

 

·        PET scan (positron emission tomography)

 

·        Ictal SPECT scan (single photon emission computed tomography)

 

·        Magnetic Source Imaging (through the University of Alabama, Birmingham)

 

·        Magnetic Resonance Spectroscopy

     

      FIRST seizure clinic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Digital Video-EEG Monitoring: EEG electrodes are applied to the scalp, and the patient's brain activity is continuously recorded.  There is also simultaneous video monitoring that allows the epilepsy doctor to correlate the behaviors during theseizure to the electrical changes seen on the EEG.  This allows accurate classification of the patient's seizures or spells.  In patients with intractable epilepsy, this test can determine where seizures begin thereby determining whether a patient is a candidate for epilepsy surgery.  The patient is in a private roomand a family member is encouraged to stay with them.  Anti-epileptic medications are usually gradually decreased to increase the chance of identifying a seizure.  The Video-EEG monitoring unit is the first of its kind PinellasCounty.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Epilepsy Protocol MRI: This is a special MRI performed with a special high resolution phase array coil the only one of its kind in the Tampa Bay area.  Unlike a routine MRI, the slice thickness is very thin at 1.5mm and the resolution is substantially greater allowing for the identification of the cause of the patient's epilepsy where previously none had been found.  These MRI films are routinely reviewed by our epilepsy neuroradiologist and epileptologist, and a monthly conference is held to review many of these MRIs.

 

 

 

 

FD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FDG-PET Scan: During this study, the patient lies quietly in a room with his eyes closed.  A tracer containing glucose sugar is injected into a vein.  This glucose is taken up by the body including the brain which utilizes a large portion of glucose.  The PET scan of the brain is the performed that measures the amount of glucose used in the brain.  Brain regions that are not functioning well, and that often are the source of the patient's seizures show reduced glucose use.  This study is particularly useful for patients that have a normal epilepsy protocol MRI and have temporal lobe epilepsy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBTRACTION ICTAL SPECT SCAN: During a seizure, the brain region where the seizure started has the greatest amount of blood flow.  During a seizure, the patient is injected with a tracer that helps to measure blood flow.  The injection is most helpful when it is given within 20 seconds of when the seizure started.  A SPECT scan is then done within two-three hours and the brain region(s) with greatest blood flow are identified.  Although this scan is done hours after the tracer is injected, an accurate image of blood flow during the seizure (ictal) is obtained since the tracer remains in the brain for up to four hours. Another SPECT (inter-ictal) scan is done at another time when the patient is not having a seizure (inter-ictal). The two scans are digitally subtracted and the resulting image provides the epilepsy team with valuable information about where the seizures begin.  This test is most valuable in patients with 1) an abnormal MRI and an EEG that does show the area of seizures onset or shows a different area of seizure onset than the MRI abnormality; 2) patients with a normal EEG with or without an EEG that identifies the area that of seizuresonset. In this figure, the region(s) in bright orange represent the area where this patient's seizures begin (the left temporal lobe).

First Seizure Clinic

The Bayfront Medical Center First Seizure Clinic, offers prompt and thorough expert evaluation of patients with new-onset seizures.

Rationale

The modern approach to epilepsy relies heavily on electroclinical syndromic classification of individuals’ seizure disorders. Such an approach informs future decision making regarding therapeutic agents, prognosis, and appropriate intensity of follow-up. In modern practice, however, the syndromic approach is rarely applied to “first seizures”, in part, because patients seldom see epileptologists early in the course of their disease. The initial evaluation of first seizure patients may be inefficient due to the overuse of unnecessary tests such as CT scanning as well as the failure to optimize some tests that are performed such as MRI. Data suggests that determining the cause of one's epileptic seizure can help predict future prognosis.

Oftentimes a patient is not seen by a neurologist or an epilepsy specialist (epileptologist) who is specially trained to diagnose epileptic seizures and the numerous medical conditions that can mimic them. Moreover, the yield of diagnostic testing, especially EEG, may be inversely proportional to the delay after an event in performing the test. Seizures are dramatic events in the life of an individual, and may cause considerable anxiety and socio-economic hardship. For many patients rapid access to a specialized epilepsy unit may lessen the anxiety associated with a potentially serious diagnosis. Early evaluation and testing may therefore improve patient satisfaction and allow more rapid optimization of treatment. In addition, the First Seizure Clinic is a unique resource for identifying patients early in the course of their illness who may be candidates for clinical trials of new diagnosis and treatment protocols.

Goals

• To provide rapid evaluation and treatment of adult and pediatric first seizure patients, including all necessary diagnostic testing
  
• To be highly responsive to the needs of the Primary Care community
  
• To work in partnership with community based neurologists in the longitudinal management of newly diagnosed seizure patients
  
• To allow ascertainment of a cohort of patients at the onset of their seizure disorder to facilitate trials of early intervention strategies, including outcomes measures
  
• To promote cost efficient strategies for the clinical evaluation of first seizure patients using prospective data
  
  

Access

Patients may be seen by either physician- or self-referral. To arrange an evaluation, call 727-553-7923 and ask for an appointment in the First Seizure Clinic. Our clinical staff (Amy Savage or Pam Pavliscek )will speak with you to determine whether evaluation in the First Seizure Clinic seems appropriate. In general patients can be seen within a few days and all necessary diagnostic testing can be arranged within one to weeks of the visit. Remember to bring copies of any medical records you have that relate to the event in question. It is also helpful to bring along a friend, co-worker, or family member who witnessed your event.

 

I. What is an Epilepsy Specialist (Epileptologist):

 An epilepsy specialist typically has an additional six years of training after medical school.  This training includes an internship in internal medicine, a three year residency in neurology and a two years of dedicated epilepsy training at an academic medical center with a comprehensive epilepsy program.

 

     

II. When looking for an epilepsy specialist, you should ask the following questions:

 

1)      Is your doctor board certified in Neurology? You can check the website of the American Board of Medical Specialties. http://www.abms.org/login.asp

 

 

2) Is your epilepsy doctor  board certified in clinical neurophysiology and epilepsy? To determine whether a physician is board certified by the American Board of Clinical Neurophysiology, contact

Janice Walbert, R. EEG/EP T.

ABCN Executive Director

1904 Croydon Dr..

Springfield, IL 62703

Phone (217) 529-0259

Fax (217) 585-6663

E-mail: jwalbert.abcn@insightbb.com

 

           3) Are the EEG technologists at the facility registered with the American Board of Registered EEG technologists?  Technologists who are certified by the ABRET take an intensive written examination. After passing this exam, they sit for an intensive oral examination.  You can determine EEG technologist certification at this website: http://www.abret.org/

 

           4) Is your epilepsy doctor part of a comprehensive level IV epilepsy program? A comprehensive epilepsy program consists of a multi-disciplinary team of experience professionals including a neurologist specializing in  epilepsy,  an epilepsy neurosurgeon, an epilepsy clinical nurse specialist, a neuropsychologist, a neuroradiologist, registered EEG technologist with experience and training in video-EEG monitoring Level IV Epilepsy Center Guidelines:  (http://www.naecepilepsy.org/PDFs/NAECguidelines.pdf)

 

 

Most Comprehensive epilepsy programs are members of the National Association of Epilepsy Centers (NAEC) http://www.naecepilepsy.org/centers/centers/html

 

Bayfront's Epilepsy Program meets and exceeds the NAEC guidelines for a level IV epilepsy program (the only one in Pasco, Pinellas and Sarasota counties and counties south).