Center for Neurology and Sleep Medicine
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About Epilepsy Care Clinic

Epilepsy is a common condition in all ages especially children. Modern diagnosis and treatment has transformed epilepsy from a devastating illness to one that can be well-controlled and treated. Epilepsy Care Clinic is at the forefront of epilepsy care offering a unique service for patients in Egypt.

Epilepsy Care Clinic has an unmatched team of neurologists and pediatric neurologists trained at the Cleveland Clinic, University of Edinburgh and University of Rome (Prof. Hoda Tomoum, Prof Rania Shatla, Dr. Sherif Elwan, Dr. Mostafa Awadh, Dr. Karim Ashraf). They are supported by team of technicians trained in Germany (University of Saarland) and in Egypt experienced in performing thousands of EEG studies.

We provide a complete range of routine and advanced EEG services, as well as expert diagnosis and treatment of all epilepsies.

How is epilepsy diagnosed?

Epilepsy is diagnosed clinically and through EEG (electroencephalography). Knowing if a person is having a seizure and diagnosing the type of seizure or epilepsy syndrome can be difficult. There are many other disorders that can cause changes in behavior and can be confused with epilepsy. Since the treatment of seizures depends on an accurate diagnosis, making sure that a person has epilepsy and knowing what kind is a critical first step.

What happens during a seizure is one of the most important pieces of information. And, since seizures rarely happen in a doctor’s office, the information given to the doctor and other health care professionals by you or other witnesses is extremely important. Yet, even with accurate descriptions of events, other tests are needed to learn more about the brain, what is causing the events and where the problem is located.

EEG test for seizures in children

This video documents the steps to setting up and preparing for a lengthy EEG test in children.

 

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  • What is an EEG?

    eeg-normal-l

    An electroencephalogram (EEG) is a test to measure the electrical activity of the brain. It is one of the main diagnostic tests for epilepsy. An EEG may also play a role in diagnosing other brain disorders too. Brain cells communicate with each other by producing tiny electrical signals. An EEG measures this activity and it shows up as wavy lines on an EEG recording.

    The test is done by a EEG specialist and then reviewed by a doctor to interpret the result.

    It is a painless procedure that uses small, flat metal discs (electrodes) attached to your scalp to detect electrical activity in your brain.

  • How do I prepare for an EEG?

    eeg

    You will need to lie still on a bed or recliner during the test with your eyes closed because movement can change the results. You may also be asked to do certain things during the test, such as breathe fast and deeply for several minutes or look at a bright flashing light.

    Wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before this test. Your doctor may want you to stop taking certain medicines before the test. Do not change or stop taking any medicines without first talking to your doctor. Bring a list of your medicines with you.

    Avoid all food and drinks containing caffeine for 8 hours before the test.

    You may need to sleep during the test. If so, you may be asked to reduce your sleep time the night before. If you are asked to sleep as little as possible before the test, do not eat or drink any caffeine, energy drinks, or other products that help you stay awake.

    For children, we may need to give them a light sedative to help them sleep during the test.

  • What is prolonged and video EEG?

    082A prolonged EEG is the same as a routine (regular) EEG but the recording is continued for many hours. This can be anything between 2 hours and 72 hours. It allows the doctors to get a complete recording of brain activity in many different situations, including sleep.

    Video recording is always done with prolonged EEG to allow linking of what happens to the patient with what is recorded onto the EEG machine.

    Prolonged EEG is very useful in determining the nature of some events, especially when the diagnosis is not clear.

Treatment of Epilepsy

When the doctor has made a diagnosis of seizures or epilepsy, the next step is to select the best form of treatment. If the seizure was caused by an underlying correctable brain condition, surgery may stop seizures. If epilepsy — that is, a continuing tendency to have seizures — is diagnosed, the doctor will usually prescribe regular use of seizure-preventing medications. If drugs are not successful, other methods may be tried, including surgery, a special diet, complementary therapy or vagus nerve stimulation (VNS). The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for people to lead active lives.

The Decision to Treat

“The decision to treat becomes a highly individualized one.”

Factors Influencing the Decision to Treat

Abnormal EEG

Previous seizure

Other neurological impairment

Elderly

When a child or adult experiences a single seizure, or appears at the doctor’s office with a history of questionable events that may or may not have been seizures, the first issue is to determine what happened, whether a seizure actually took place, of what type and duration it was, the possible cause, and the future prognosis. Once this information is gathered, the next question is whether to treat the underlying condition (if one has been identified and if it is treatable), or whether to treat the symptoms by prescribing antiepileptic (or seizure-preventing) drugs.

Factors Influencing the Decision Not to Treat

Single seizure

No history

Neurologically normal

Young age

Side effects

Unless the EEG is clearly abnormal, thus increasing the likelihood of subsequent seizures, physicians tend to wait until a second or even third seizure occurs before beginning antiepileptic medication. They do so because studies show that an otherwise normal child who has had a single seizure has a relatively low (15%) risk of a second one. Once the second has occurred, the risk of subsequent seizures is substantially increased. On the other hand, the risk of another seizure for a child who is neurologically abnormal, or whose EEG is abnormal, may be as high as 50-60%. In determining whether to treat, physicians consider the risk-benefit ratio, which varies according to the age of the patient and his or her activity level. Waiting to see whether another generalized tonic-clonic seizure occurs is less risky for a child living in a sheltered home environment than it is for a salesman who lives most of his life driving a car, or an elderly person with brittle bones. On the other hand, antiepileptic drugs have side effects which, while generally mild, can in some cases include liver damage and potentially fatal rashes and blood disorders. Therefore the decision to treat becomes a highly individualized one in which the risks of the treatment are weighed against the risks of the seizures. There is debate about whether or not children with febrile (fever caused) seizures should be placed on antiepileptic drugs. Current opinion favors withholding therapy for most of these children, since side effects of the medication may cause more problems than recurrent febrile convulsions. There may be instances, however, when treatment is prescribed.

 (source: epilepsyfoundation.org)