Neurology & Epilepsy

Mount Lebanon Hospital department of epilepsy and sleep monitoring is equipped with the most advanced diagnostic tools. A dedicated team of neurologists and neurosurgeons have an established expertise in evaluating and treating the condition.

Video-EEG monitoring or long-term monitoring for epilepsy (LTME) refers to the simultaneous recording of EEG and clinical behavior over extended periods of time to evaluate patients with paroxysmal events. It is used when it is important to correlate clinical behavior with EEG phenomena. EEG recordings of long duration may be useful in a variety of situations in which patients have intermittent disturbances that are difficult to record during routine EEG sessions.

This video-EEG monitoring helps the physician answering the following questions:

Are the episodes recorded epileptic seizures or not.

If Epileptic, what epilepsy type is it? Where are the seizures arising from? (brain region?)

Having these questions answered will subsequently guide treatment, and mostly will help deciding whether the patient can be cured from his epilepsy by any surgery type.

So any patient with frequent seizures despite two appropriate medication trials could benefit from such an evaluation.

Technical aspects

Patient is admitted electively or urgently depending on the situation. If the admission is elective anti-epileptic drugs may be decreased or stopped while in the hospital if the frequency of the events is not high enough. A reduction of the medications can even be initiated prior to admission. This is very individual, and there is no standard protocol

The monitoring is performed in a fixed room available on the 4th floor, which was wired to a network including a camera fixed to the wall. It visually records all the patient’s movements while in the unit and transmits that to a monitor at the nurses’ station. Privacy is respected and a specialized nurse is available at all times to observe the patient, test him and assist him as needed.

The video signal is digitized and synchronized to the EEG signal. They are displayed simultaneously and reviewed and analyzed by our epileptologist.

Our unit at Mount Lebanon Hospital is equipped to prepare for epilepsy surgery by completing scalp video-EEG and if needed recording from intracranial implantation of EEG electrodes. Additional imaging studies can be performed to help the surgical decision, particularly ictal PET and SPECT (injection of product at seizure onset then imaging is performed). As of January 2012, the unit is upgraded with the state of the art cortical stimulator, the only one available of its kind in the Middle East to assist and map for epilepsy surgery and other brain surgery types. It is assigned to record after stimulating the brain through electrodes implanted on the brain surface to test for language and motor function and other functions. Its main role is to guide surgical resection, extent and safety.

The sleep lab helps in evaluating sleep related pathologies and consists mostly on performing a polysomnogram or PSG, which is a recording of multiple physiological parameters during sleep, in addition to a detailed history taking from the patient and performing additional tests such as MSLT (multiple sleep latency test), full head EEG, CPAP titration depending on the clinical indication.

The PSG is performed on Alice 5 machine in a designated room on the 4th floor.

Indications for a PSG:

1. Sleep related breathing disorders, mostly excessive snoring and apneas during sleep or excessive daytime somnolence. At times titration of CPAP is needed.
2. Narcolepsy or idiopathic hypersomnia
3. Cyclic nocturnal arrhythmias and related symptoms
4. Atypical, violent or potentially injurious parasomnias
5. Nocturnal seizures
6. Insomnias, mostly when breathing disorder suspected or periodic limb movement suspected, initial diagnosis is uncertain or arousals occur with violent or injurious behavior