What to Expect

Your preliminary evaluation is performed by a board-certified neurologist with subspecialty training in epilepsy. It includes:

1. A detailed history of your seizure activity and anticonvulsant drug regimens to help define the type of epilepsy you have and to determine whether it is resistant to medical treatment
2. Outpatient testing to screen for abnormalities within the brain
3. Inpatient EEG recordings to identify where, within the brain, the seizures begin

Your doctor will also need to know about a family history of seizures or other similar conditions and medications prescribed.

What questions is my doctor seeking to answer?

If you are evaluated for suspected seizures or epilepsy, your doctor will work to answer these questions:

• Have you had an epileptic seizure or something else?
• What is the cause? If a cause is identified, can it be treated?
• What is the seizure type?
• What is the outlook?

For Our Adult Patients

During your first appointment you will meet with members of our Epilepsy Team. They will take your medical history, perform a physical examination and complete a series of neurological and blood tests.

Although your tests will be performed as quickly as possible, you should expect some waiting; you may want to bring some reading material to help pass the time.

For Our Pediatric Patients

If you are the parent or the caretaker of a child or adolescent, the first appointment will take place in the outpatient department of the Cleveland Clinic Children’s Hospital, located on the 7th floor of the S building (desk S-71).

A physician who specializes in epilepsy will meet with you to gather information about your child’s medical history and perform a physical examination. Towards the end of this visit, the physician will discuss with you the initial diagnostic impression and suggest the tests that will be pertinent for your child’s epilepsy type, as well as discuss some possible treatment options. This type of visit will typically take one to two hours.

For Our Adult Patients

Your past medical record is very helpful to us. On the day of your appointment, please bring your actual films, CD/DVD and test results of any X-ray, angiography, MRI, CAT or CT and/or your EEG records that relate to your medical condition. Also, if you have recently been in the hospital (other than Cleveland Clinic), please bring a copy of your hospital discharge summary sheet, as well as other relevant hospital information. Your local physician can help you obtain these items.

For Our Pediatric Patients

A family member or a caregiver who has witnessed some of the child’s seizures should accompany the child during the clinic visit. This is essential in obtaining details of the seizures. You should closely work with your child’s regular medical care provider and obtain records of all previous testing that has been performed.

Previous EEG reports, summaries of video/EEG evaluations, CT, MRI films and other laboratory tests form an important part of the medical history of a child with epilepsy. It is best to bring these records physically with you to your first appointment; sending them via mail adds unnecessary delays to the procurement of the records. You may prepare (ahead of time) a list of all the previous and current antiepileptic medications, including information about the dose used and the duration for which they were given. You may also bring the bottles of the current medications that your child is prescribed.

Important questions that you should prepare for include:

• At what age did the seizures begin?
• What circumstances surrounded your first seizure? 
• What factors seem to bring on the seizures? 
• What do you feel before, during and after the seizures? 
• How long do the seizures last?  
• Have you been treated for epilepsy before?  
• Which medications were prescribed and at what dosages?  
• Was the treatment effective?

If other individuals have seen you during a seizure, such as family members or close friends, they should be present to provide details because you may not have been aware of what was happening.

Most of the patients who come to Cleveland Clinic for a comprehensive epilepsy evaluation will be prescheduled for an outpatient EEG prior to their initial clinic visit.

The EEG is an especially important part of the evaluation because seizures are defined by abnormal electrical activity in the brain. This test is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.

However, it is not uncommon for routine outpatient EEGs to show normal results in patients with epilepsy. Repeat EEGs after sleep deprivation can increase the chance of finding an abnormality.

When routine outpatient EEG studies fail to provide the needed information, prolonged EEG monitoring may be necessary. Particularly, if the diagnosis is not clear, or the patient may be a potential candidate for epilepsy surgery, they will need to undergo an Epilepsy Monitoring Unit evaluation.

The family is contacted by our epilepsy nursing staff for scheduling a return visit to the Epilepsy Monitoring Unit with the next available opening. Further tests (as may be indicated) are scheduled around this visit to coordinate a streamlined efficient visit for the convenience of the patient and their families. Such tests may include: MRI, PET, SPECT, WADA test, neuropsychology evaluation etc. As part of the evaluation, your doctor will need to perform additional tests, including:

• A complete physical and neurological examination of muscle strength, reflexes, eyesight, hearing and ability to detect various sensations.
• Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI).
• Blood tests to measure red and white blood cell counts, blood sugar, and blood calcium and electrolyte levels, and to evaluate liver and kidney function. Blood tests help rule out the presence of other illnesses.
• An electroencephalogram (EEG), which measures electrical impulses in the brain.

The expected length of stay is three to five days. The duration of stay largely depends upon the frequency and complexity of seizures and the necessity of doing additional testing (e.g. SPECT scan).

In the case of a diagnostic evaluation where surgery is not being considered, the expected length of stay is three to five days. However, for a presurgical evaluation where additional testing (e.g. SPECT) and consultations (e.g. neuropsychological evaluation) might be indicated, the length of stay is five to seven days.

Most of the time, you will stay in bed or in a reclining chair next to your bed. You will be disconnected from the equipment to get up and move about twice a day. You also will be disconnected to use the restroom and to shower. Having a family member or staff person accompany you on all walks is required for your safety as your medication will be reduced or discontinued. For your safety, we also limit your walking within the unit itself.

Children are encouraged to bring along their favorite blankets, toys, books, pacifiers or other comfort items. Feel free to bring any photographs, pictures or small items that will make your child’s room seem more like home.

Parents are encouraged to stay around-the-clock with their child, though only one person may stay overnight. After monitoring is completed, young patients are welcome to use the playroom and playdeck. The playroom and playdeck are located in Cleveland Clinic Children’s Hospital, where the Pediatric Monitoring Unit is located.

Download our Monitoring Unit Brochure

At the end of the evaluation, the physician will provide you with a summary impression from the information gathered from the testing and provide further recommendations for a treatment plan. Within the following few days, your referring physician (unless otherwise specified) can expect to receive a copy of the complete evaluation and further recommendations.

Epilepsy is a disorder that needs very close follow-up care on an ongoing basis. We like to work very closely with your referring physicians in providing them with feedback and future recommendations whenever needed. In many cases, medication levels and prescriptions are best handled by a follow-up closer to home with the regular physician. However, we would like to stay available for further consultation and follow-up visits at any time in the future.