More Information on Tests

Long-term Video EEG Monitoring

Long-term continuous video EEG monitoring is done during an inpatient hospital stay that can last from five to seven days. The goal of this evaluation is to record your typical seizures using a video camera and continuous EEG monitoring so that your doctor can better diagnose and treat you. This test helps doctors better understand and localize where in the brain your seizures come from and provides much more information than a traditional EEG, which lasts about a half hour and gives merely a snapshot of the brain’s activity during the particular time of the recording period. This may not be sufficient to give us the information we need to treat your seizures adequately.  View a video about Long-term Video EEG Monitoring.

The test has two components:

Audio/Video:

A microphone and camera will record all your physical activity while you are on the EEG for review. Monitors are placed at the nursing station facing away from traffic areas to protect your privacy. The EEG technologists in the monitoring control room are available between 7 a.m. and 7 p.m. during the weekdays. By videotaping your seizures we can see exactly what happens during one of your seizures. This is usually more accurate than reports you or a family member can give us about your seizures.

EEG Recording:

This part of the test allows us to detect seizure activity that may occur, even if you are not aware it is happening. It helps us determine the type of seizure you are experiencing and may provide helpful information to improve your treatment. It also gives us information about how your brain functions between seizures. This type of recording allows us to make an accurate count of your seizures and to see if you might have more than one type of seizure.

What is a Wada Test?

The Wada Test helps your doctors understand how your brain is organized, specifically, in terms of language and memory functions. This is a routine procedure for patients who are being evaluated for certain types of brain surgery, such as surgery for epilepsy or for certain brain tumors. This information will be valuable to your surgeon during the surgery. The procedure is not painful.

The test is performed by a team of doctors, including your neurologist, a neuro-psychologist and a doctor performing an angiogram.

What do I need to do before the test?
  • You will need to have routine blood tests, including a chemistry profile, complete blood count, clotting tests and usually anti-epileptic drug levels done within 2-3 weeks of the test.  This can be done during a separate visit to Brigham and Women’s or by special arrangement with a laboratory near your home. The test results, if obtained from a facility outside of Brigham and Women’s, will need to be faxed to 617-734-8342, attn:  Kristin Lewis, ANP-BC .
  • If you are taking Coumadin (Warfarin), call your doctor five days before the procedure. It will be necessary to stop taking it before your procedure.
  • Let us know if you have an allergy to x-ray contrast so that we can take the necessary precautions.  If you are allergic to contrast, you may need to take medications beginning the day before the procedure to reduce risk of an allergic reaction.
  • Make plans for someone to come with you to your procedure. During the procedure you may receive medicine that will make you drowsy.  You will not be able to drive afterwards. Please have someone available to drive you home.
  • Someone needs to stay with you overnight.
The Day Before the Procedure:
  • Do not eat or drink anything after midnight.
  • You should take your routine medications, both the night before and the morning of the procedure (or as scheduled), with a small sip of water. Diabetics, however, should read the "Special instructions for patients with diabetes" section.
On the Day of Your Procedure:

Bring all your medications with you on the day of the procedure so we can review them.

  • Arrive at Brigham and Women’s Hospital, 75 Francis St. (main entrance), at 6:30 a.m.
  • Valet service is available at the main entrance.
  • If you choose to self-park at the Mission Hill Garage, walk up the street and enter the main entrance of 75 Francis St. 
  • At the main entrance, you will find an escalator and elevator immediately to your right as you walk through the door. Take the escalator/elevator to the second floor. Take a left off the escalator/elevator and follow the sign directing you to the Shapiro Center.  As soon as you enter the Shapiro Center, you will find the Family Waiting area on the right.  You will check in at the front desk here.
  • Once you check in at the Shapiro Center, a nurse will call your name and bring you to the pre-procedure room.
  • The person accompanying you will be asked to wait in the Family Waiting area while we prepare you for the procedure. When you are ready, you can be joined by the person who is accompanying you in the recovery room until it is time for your procedure. They can also rejoin you after the procedure.
Special instructions for patients with diabetes:

For those who take insulin regularly, take half your NPH dose and half your normal dose of regular insulin on the day of the procedure. Please remind your Doctor or Nurse Practitioner about any diabetic medications you take.  If you regularly take Metformin or any Metformin containing medications (for example: Glucophage, Glucophage XR, Glucovance or  Glyburide), you should  not take it  the day of the procedure. You will need to have your labs checked in 48 hours before restarting the Metformin or Metformin containing medication.

Immediately before your angiogram:
  • You will be asked to put on a hospital gown and to remove any jewelry, dentures, hair clips or other metal objects that may block the x-ray.
  • An Intravenous (IV) line will be placed in your arm. The IV will be used to give you fluids and other medicines.
  • You may also have blood drawn before the procedure.
  • Before the test, EEG electrodes will be placed on your head so that your brain electrical activity can be monitored. 
  • A member of the team that does the angiogram portion of the test (the neuron interventional team) will talk with you about the procedure in detail, answer your questions and discuss possible risks, and will ask you to sign a consent form for the procedure.
What happens during the procedure?
  • You will be brought into the procedure room and positioned lying flat on an x-ray table with your head in a cradle.
  • You will be connected to monitoring devices so the nurse can monitor your blood pressure, heart rate and breathing throughout the procedure. 
  • A radiology medical technician will shave and disinfect your groin area to help prevent infection.  The doctor performing the angiogram will then inject numbing medicine into the cleansed groin area, similar to the numbing at a dental procedure.  It is a slight pinch. You should feel only minimal  discomfort, if any, during the ENTIRE procedure after your groin is numb. 
  • After your groin is numb, we will insert a thin tube called a catheter into a blood vessel in your groin. The doctor will guide the catheter to the area that is to be studied by watching it on a TV-like monitor. 
  • Contrast (dye) is injected into the catheter to make the blood vessels visible.
  • Several x-rays may be taken and you will be asked to hold your breath and keep very still during this part of the procedure. 
  • When the dye is injected, some people report a warm sensation or hot feeling in their face or head.  Some patients may have a funny taste in their mouth, a sharp headache, or see flashing lights.  These sensations are normal and last only briefly.
  • At this point, a Neuropsychologist and Neurologist will come into the procedure room. A medication (sodium amytal) is injected through the catheter and travels through your blood vessels to one side of your brain. The medication will put part of your brain to sleep for a short period of time.
  • During this time, you will be asked questions to test your language and memory functions, using the part of your brain that is awake.
  • Once this is done, your doctors will discuss the results and decide whether to perform the same test on the other side of your brain. The majority of patients have both sides tested. There will be an intermission of approximately 45 minutes between the two tests. The doctor performing the angiogram will then reposition the catheter, and the procedure will be repeated on the other side of your brain. 
  • The majority of patients feel essentially back to normal after 20 to 30 minutes.
What happens after the procedure?
  • When the procedure is completed, the catheter in your groin will be removed. Pressure will be applied to your groin, where the catheter was removed, to stop any bleeding. A dressing will then be applied, which you will remove the following day.
  • You will lay flat in bed with your affected leg straight for about four to six hours.  his allows the small hole in the artery (where the groin catheter was inserted) to seal.
  • At the end of the four to six hours, you will be allowed to get out of bed to a chair. When you feel well enough, you may go home. 
  • You are encouraged to drink plenty of fluids to flush out the dye (approximately two liters in 24 hours). You may resume your regular diet.  You may continue to take your regular medicine.
Discharge Instructions
  • After discharge, take it easy for the next 72 hours. The day you come home from your procedure, you are instructed to rest with as little walking as necessary. You should avoid going up and down stairs. You may sleep, watch TV and read.
  • DAY #1 (the day after your procedure): You may start to increase your walking, but only minimal walking.  Continue to mostly rest. DAY #2 (the second day after your procedure): You may resume regular (not strenuous) walking. 
  • Do NOT do any strenuous activity or lift anything heavier than a carton of milk for 72 hours after the procedure.  Try not to go up and down stairs too frequently.
  • You should not drive for at least 48 hours.
  • There will be a dressing over your groin.  You may remove it after 24 hours, but keep the area clean and dry.  Although you may shower with no dressing on your groin after 24 hours, please place a band-aid at the puncture site after showering.
  • It is normal to have a little more discomfort in your groin the day after the procedure.  You may have slightly more bruising at the puncture site. This is normal.  You may take acetaminophen in regular or extra strength to minimize the discomfort.
  • Your doctor or nurse practitioner will contact you within a couple of days after your procedure to see how you are feeling and discuss any follow-up plan.
If you should develop bleeding at your groin site, apply direct pressure for 15-20 minutes.

If the bleeding persists, continue to hold pressure and call 911 or go to the emergency department. Go to the Emergency Room immediately if you experience any of the following:

  • numbness, tingling or weakness in your leg, arm or face.
  • trouble talking, understanding or swallowing.
  • changes in your vision.
  • confusion.
  • shortness-of-breath or chest pain.
When is my follow-up appointment?

Follow-up is with your neurologist.

Valet service is available at the main entrance.

  • If you choose to self-park at the Mission Hill Garage, walk up the street and enter the main entrance of 75 Francis St. 

  • At the main entrance, you will find an escalator and elevator immediately to your right as you walk through the door. Take the escalator/elevator to the second floor. Take a left off the escalator/elevator and follow the sign directing you to the Shapiro Center.  As soon as you enter the Shapiro Center, you will find the Family Waiting area on the right.  You will check in at the front desk here.

  • Once you check in at the Shapiro Center, a nurse will call your name and bring you to the pre-procedure room.

  • The person accompanying you will be asked to wait in the Family Waiting area while we prepare you for the procedure. When you are ready, you can be joined by the person who is accompanying you in the recovery room until it is time for your procedure. They can also rejoin you after the procedure.

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