I need an appointment
Please call (216) 444-5559 or 1-800-CCF-CARE, ext. 45559 to make
an appointment. If you wish to set up an appointment via internet,
please click on the link ??CCF/epilepsy/appointments??. Should
you need to reach a physician after hours, call 1-800-CCF-CARE
and ask the operator to page the pediatric epilepsy fellow on
call.
What to expect during
my first appointment?
Your first appointment would be in the outpatient department of
the Cleveland Clinic Children's Hospital. We are located on the
7th floor of the S building (desk S-71). A physician, who specializes
in epilepsy, would 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 would discuss with you the
initial diagnostic impression, suggest the tests, which would
be pertinent for your child's epilepsy type as well as discuss
some possible treatment options.
Such a visit would typically take 1-2 hours.
What
do I need to bring to my first appointment?
A family member (or a caregiver) who has witnessed some of the
child's seizures should accompany during the clinic visit. This
is essential in obtaining the details of the nature of the seizures.
You should closely work with your child's regular
medical care provider and obtain records of all previous testing
that have 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 in a timely fashion.
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 on.
What testing would
occur?
Most of the patients who come to the Cleveland Clinic for a comprehensive
evaluation of their epilepsy would be prescheduled for an outpatient
EEG prior to their initial clinic visit. If the diagnosis is not
clear or if they may be potential candidates for epilepsy surgery
they would need to undergo 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 patient and their families. Such tests may include
MRI, PET, SPECT, WADA test, neuropsychology evaluation etc.
Electroencephalograph (EEG)
The EEG is a record of the patient's electrical brain activity.
It is carried out by placing an array of electrodes on the patient's
scalp, held temporarily in place with an adhesive. Disturbance
of brain waves can provide significant clues to the nature of
an epileptic syndrome. An outpatient EEG recording usually takes
up to 1-2 hours. The yield of information increases if a sleep
recording can also be obtained. To facilitate this, we recommend
that you limit the patient's sleep to 4-6 hours during the previous
24 hours. This enables the patient to fall asleep during the recording.
Video-EEG
monitoring
Video EEG monitoring is carried out in the six-bed PEMU (Pediatric
Epilepsy Monitoring Unit), which is staffed by a highly trained
team of pediatric epileptologists, nurses, and technicians. This
completely computerized unit is one of only a handful of such
units in the country specifically devoted to children with epilepsy.
Digital recording of the EEG as well as the video signals results
in easy manipulation of large amounts of highest quality data,
making this a state of the art facility.
After the clinic appointment you would be admitted
to the pediatric epilepsy-monitoring unit, where a more detailed,
sensitive, and careful study of the clinical and EEG features
of the seizures may be accomplished. This monitoring process involves
continuous EEG recording with video observation of the seizures.
This analysis is typically performed in children with uncontrolled
seizures and is part of the normal workup for children being considered
for epilepsy surgery. Child life specialists provide emotional
support to parents and children during their stay in the monitoring
unit.
The expected length of stay is 3-5 days. The duration
of stay largely depends upon the frequency and complexity of seizures
as well as the necessity of doing additional testing (for e.g.
SPECT scan). In the case of a diagnostic evaluation where surgery
is not being considered, the expected length of stay is 3-5 days.
However, for a presurgical evaluation where additional testing
(for e.g. SPECT) and consultations (for e.g. neuropsychology evaluation)
might be indicated, the length of stay is 5-7 days.
What would
I take home with me?
At the end of the evaluation, the physician would be able to provide
you with a summary impression from the information available from
the testing and 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 a 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 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.
