LONG BRANCH, NJ, January 6, 2011 – Epilepsy is one of the most treatable chronic medical conditions, yet effective treatment of epileptic seizures often proves elusive.
At Monmouth Medical Center, the goal of the new Epilepsy Monitoring Program is to improve seizure control and quality of life for adults and children suffering from epilepsy.
The program, which debuted in December, is led by neurologist Joshua Mendelson, M.D., who completed fellowship training in Clinical Neurophysiology at Atlanta's Emory University with a special concentration in the medical and surgical management of epilepsy.
Central to the Epilepsy Monitoring Program is state-of-the-art technology that provides continuous video and EEG (electroencephalography) monitoring of electrical activity in the brain. Dr. Mendelson, a clinical assistant professor at Drexel University College of Medicine, Monmouth’s teaching affiliate, says comprehensive monitoring programs can provide help to people with medically resistant epilepsy, to improve both seizure control and quality of life.
Through the program, Dr. Mendelson works with a dedicated EEG technologist and nurses on the adult and pediatric inpatient units who have received special training in the care of patients with epilepsy, a medical condition affecting children and adults that produces brief but strong electrical surges in the brain that affect various mental and physical functions. He also works closely with Monmouth Medical Center director of pediatric neurology, Shirley Fisch, M.D., attending neurologists and primary care physicians in developing treatment options for the patients.
During a hospital stay that averages three days, patients are monitored from their hospital beds via a mobile EEG unit. The goal is to observe or trigger seizures in a protected environment, so that a more precise diagnosis can be made.
“Brain activity is recorded using digital and quantitative EEG 24 hours a day, and patients are videotaped to capture the behavioral changes and body movements that occur during seizures for later analysis,” Dr. Mendelson says.
Through a network that uses cameras fixed in the patient rooms that are linked to a central server, the video signal is digitized and synchronized. The camera is used to visually record all the physical activities of the patient while in the monitoring unit, and at the same time, the EEG is recording the brain activity.
A monitor at the nurses' station enables the patient to be observed throughout their stay. Additionally, both EEG and video signals are displayed simultaneously for online observation by Dr. Mendelson, who can then confer with the referring physician remotely on what they observe in the patient.
According to Dr. Mendelson, there are many different types of seizures a patient with epilepsy may experience, and accurate diagnosis of seizure types aids in the appropriate selection of medications or other treatment recommendations.
“The EEG is a critical test in assessing epilepsy, but seizures are unlikely to happen during a routine outpatient test,” Dr. Mendelson says.
He notes that the brain produces specific electrical abnormalities, called spikes or sharp waves, which occur in between seizures, and that these EEG abnormalities can help determine whether the seizures begin in a focal or generalized fashion, and may allow classification into a specific type of epilepsy.
“A standard EEG test typically lasts 20 minutes and only offers a brief snapshot of a brain's activity within a limited time frame,” Dr. Mendelson says. “However, continuous monitoring can help when the diagnosis of epilepsy, the particular seizure type or location in the brain is not clear on routine EEG recordings.”
He notes that with currently available treatment options, many people can benefit from reduced seizure frequency and/or reduced side effects, resulting in improved quality of life. And for many epilepsy patients, the only way to offer better treatment is to monitor them and study what occurs during an actual seizure, Dr. Mendelson says.
“There has been dramatic progress in medical therapy in recent years, and this increase in treatment options allows much more flexibility in designing a medication regimen to meet patients’ specific needs, often with fewer side effects,” he adds. “The results of video-EEG testing may show that the original diagnosis of epilepsy type was wrong, and allow a change to more effective medications, or that the patient may be a candidate for alternative therapies such as brain surgery. In many cases, it turns out that the behavior in question was not an epileptic seizure at all, even in people who also have true epileptic seizures, such non-epileptic events are usually treatable once recognized.”
To learn more about the Epilepsy Monitoring Program at Monmouth Medical Center, call 732-923-6839.
Neurologist Joshua Mendelson, M.D., confers with EEG technician Eleni Argyropoulos
January 6 , 2011
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