Freiburg Epilepsy CenterDepartment of Neurosurgery

The EEG is essential for the diagnosis of epilepsy. Video EEG monitoring is also necessary to assess the options and chances of success of an operation. This involves measuring brain waves over a period of 24 hours. Additional filming during electroencephalography can often provide a clearer diagnosis. In this way, changes in consciousness, special cognitive abilities, heart rhythm or movements, which are typical of epilepsy, can be detected and compared with the EEG.  For long-term monitoring, electrodes are attached to the scalp with a special adhesive. This allows the EEG to be recorded around the clock. With the a goal of recording an epileptic seizure, a camera is also directed at you for the complete recording periods. In this way we obtain information about the course of your seizures and the associated changes in the EEG. To increase the likelihood of seizures to occur, your medication is usually reduced for the duration of your stay. The long-term EEG is completely painless for patients, but severe seizures may occur if you stop taking your medication. In this case, the team at the Epilepsy Centre is always available to help you.   For long-term EEG monitoring, our Epilepsy Centre has a total of seven recording placess in five patient rooms. Two of the rooms are furnished as family rooms or mother-child units, so that your child can be accompanied during the diagnostic process.

In cooperation with the in-house Department of Neuroradiology, images of the brain are taken to understand possible causes of epileptic seizures. Due to its high sensitivity, magnetic resonance imaging is the neuroradiological method of choice in epilepsy. The examination procedure is free of risks for the patient. In contrast to computer tomography, MRI does not use X-rays and is able to produce very high-resolution images in 30 minutes. The examination is carried out at the Neurocentre Freiburg using the latest generation of MRI equipment. A detailed description of the examination and further information can be found there.

For children who still have difficulties with the course of the examination, we MRI appointments can be prepared in a playful way  or under short anaesthesia.

Since it is important to keep the head very steady during the examination, one parent is present during the entire procedure and can maintain eye and body contact with the child. The child can also watch a film on a special type of helmet for the duration of the examination. For children from around 6 years of age, the examination can often be mastered well with this type of helmet.

Furthermore, we also offer a playful preparation for the MRI examination. Here, children between the ages of 5 and 10 years and together with their parents are explained the MRI and the performance of the examination in an age-appropriate manner. This preparation contributes to the motivation of the children and helps to make the examination a success. Further information can be found here.

In order to obtain knowledge on location of specific brain functions (for example language, movement or vision), so-called "functional" MRI images can be taken. These images are taken, for example, during the processing of language tasks.

SPECT (single photon emission computed tomography) and PET (positron emission tomography) are nuclear medical procedures, with which certain body functions can be imaged with the help of radioactive substances. In both procedures, a slightly radioactive substance (radiopharmaceutical) is administered. After a certain waiting time, imaging is performed with a special camera.

In epilepsy diagnostics, PET is used to examine the various metabolic activities of the different brain areas. In patients with epilepsy, the metabolic activity of the different areas of the brain is increased during a seizure, but decreased between seizures. With the aid of PET, it is often possible to detect disturbances in brain tissue that are not visible on MRI. Therefore, the areas of the brain that generate seizures are identified by PET before surgery.  Both examinations are associated with low radiation exposure. Depending on the type of examination, we will give you further information to keep the radiation exposure as low as possible. The radioactively labelled substances (isotopes) are quickly broken down after the examination.

In a neuropsychological examination possible changes in mental performance (the so-called cognitive functions) are recorded. Among the cognitive abilities frequently examined are attention and memory performance, but also linguistic and visual skills as well as higher mental functions such as problem solving and logical reasoning. These achievements are examined in more details using so-called paper-and-pencil methods or computer-based tests. Depending on the question, such an examination can take several hours.

Your psychological well-being and quality of life are also important to us. These are assessed by means of questionnaires, which form the basis for consultations and therapy.

In rare cases, a so-called Wada test is performed before an operation. Here, for example, various speech functions are tested while the brain region to be operated on is anaesthetised for a few minutes. This is done with the help of a drug (barbiturate) administered through a catheter into the blood vessels supplying the brain. The imaging of the blood vessels required for this is called angiography; more information on the procedure can be found here.