Tests before epilepsy brain surgery

Before your child is accepted for surgery the epilepsy specialist, and a number of other specialists at the CESS centre will thoroughly assess your child. This is to see if they might benefit from epilepsy brain surgery. During the assessment, the specialist is likely to order various tests, which may include: 

• Electroencephalogram (EEG)/video telemetry
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI scan)
• Functional MRI scan (fMRI)
• Positron emission tomography (PET scan)
• Single-photon emission computed tomography (SPECT scan)
• Magnetoencephalography (MEG scan)
• Neuropsychology tests
• Neuropsychiatry tests

Electroencephalogram (EEG)/video telemetry

The EEG tells the doctors about the electrical activity in the brain. During the EEG, a technician places harmless electrodes on the scalp, using a special glue or sticky tape. The electrodes are then connected to the EEG machine, which records the electrical signals in the brain on a computer. A video recording might be done at the same time. This is called video telemetry and will be done in hospital. In this way, if your child has a seizure, doctors can see exactly what happens. An EEG/video telemetry can be done while your child is awake or asleep, or both. 

Epilepsy Action has more information about EEGs and video telemetry.

Computed tomography (CT scan) 

This is a type of X-ray that shows the structure of the brain. It wouldn’t show if your child has epilepsy. However, it might show if there is an abnormality that could cause epilepsy. However, CT is now an old investigation and has been replaced with magnetic resonance imaging (MRI).

Epilepsy Action has more information about CT scans.

Magnetic resonance imaging (MRI scan)

The MRI uses radio waves and a magnetic field, rather than X-rays. Like the CT scan, it can show if there’s a structural cause for the epilepsy.

The MRI is more powerful than the CT scanner, so it can pick up small or subtle abnormalities that the CT scanner can’t find.

Epilepsy Action has more information about MRI scans.

Functional MRI scan (fMRI scan)

This is similar to having an MRI scan but, during the scan, your child would be asked to do something. For example, they might be asked to tap their thumb against their fingers. Or they may be asked to look at pictures, or answer questions, on a computer screen. These activities increase the flow of oxygen-rich blood to a particular part of the brain.

This type of MRI scan will help to show exactly which part of the brain manages important tasks such as thought, speech, movement, and sensation.

For more information about functional MRI scans go to the Psych Central website. 

Positron emission tomography (PET scan)

This scan uses a radioactive substance, called a tracer, to look for information about how the brain is working. It can also show any abnormalities.

For more information about PET scans go to NHS UK website.

Single-photon emission computed tomography (SPECT scan) 

This scan shows different parts of the brain in different colours. Your child will be given an injection of a radioactive dye, which goes to their brain. The colours show how much blood flow is in each part of the brain. Usually, blood flow is higher in the part of the brain where seizures start. There are two sorts of SPECT scans. One is the inter-ictal SPECT scan, which is done between a child’s seizures (‘inter’ means between and ‘ictal’ means a seizure). The other is the ictal SPECT scan, which is done just after a child has had a seizure.

For more information about SPECT scans go to the GOSH website

Magnetoencephalography (MEG scan) 

This is a new type of scan, and is only available in very special circumstances. The scanner sits outside your child’s head and measures their brain activity. It can tell which parts of your child’s brain are active during a certain task, and at what point in time it was active. Your child won’t feel any differently afterwards, and they won’t need to change their activities or rest after their scan.

Neuropsychology tests

These tests show if your child has any memory and learning problems. The tests may take up to eight hours, split into different sessions and involve a number of games and puzzles. They can show whether the part of the brain that needs removing is responsible for any functions that other parts of the brain can’t take over. This is to try to make sure your child would not have problems after surgery that they didn’t have before.

For more information about neuropsychology tests go to GOSH website.

Neuropsychiatry tests 

A psychiatrist with experience of epilepsy brain surgery would see you and your child, as part of the initial assessment. The psychiatrist will consider whether your child has emotional and behaviour problems, which can be common in children with epilepsy. These problems often cause distress and can interfere with school and family life. But they can usually be treated.

The psychiatrist will advise you about whether your child will need any treatment for emotional or behaviour problems. This will be available whether, or not, your child goes on to have surgery. The psychiatrist will also be one of the people who checks with you what your aims and expectations are for surgery.

For more information about neuropsychiatry tests go to GOSH website

Other assessments 

Other types of assessment might be organised, depending on the type of epilepsy, and the type of problems, your child has. These may include the following assessments.

• Speech and language 
• Development
• Vision, particularly their peripheral vision 
• The need for occupational therapy
• The need for physiotherapy

For more information about other assessments go to GOSH website

What you can expect if your child has epilepsy brain surgery

The four CESS centres have been selected to provide the highest standard of care for you and your child. They each have an expert team of surgeons, doctors, healthcare professionals, and specialist facilities needed for epilepsy brain surgery. 
The centres need to make sure you and your child have access to the following support and services. This is during your assessment, as well as before, during and after the surgery.

• A chance to visit the centre and meet the team who will do the operation before the surgery takes place.
• Family support for the period in the hospital in a child friendly environment with suitable toys, books and activities appropriate for your child.
• A management plan, that is agreed with you and your child, and shared with you both, on an ongoing basis. This plan will include details about your child’s follow up care, monitoring and review.
• A named lead doctor or healthcare professional responsible for coordinating your child’s care. They will act as a link between you and the people treating your child.
• 24 hours a day access to a member of the team for advice, information and support.
• Access to an epilepsy specialist nurse.
• Clear information about your child’s condition, which should include
• A description of their epilepsy
• How their epilepsy will be managed
• Medicines and other treatments they might receive
• How you and your child get the best from their treatment 
• Emotional and behaviour support 
• Access to appropriate patient support group and charities 
• Contact details of your child’s named nurse