Mayo Clinic Hospital at Mayo Clinic in Florida has been designated a Level 4 Epilepsy Center by the National Association of Epilepsy Centers (NAEC). Level 4 centers are capable of providing care for the most complex cases. Services at Mayo Clinic in Florida have advanced to include:
The comprehensive epilepsy center at Mayo Clinic in Florida, directed by Jerry J. Shih, M.D., includes an EMU that has expanded to 5 beds and is adjacent to the neurophysiology laboratory in the new hospital.
In addition, mobile video-EEG monitoring capability allows technicians in the EMU to monitor patients in the neurosurgical intensive care unit who are at risk of seizures or have undergone epilepsy surgery. Intraoperative MRI also is available.
William Tatum, D.O., director of the EMU, notes that the new facilities provide optimal coordination between inpatient and outpatient evaluations for epilepsy and other seizure disorders.
Patients in the EMU are safely monitored in a controlled environment with comprehensive monitoring and neurologic nursing care while their routine doses of antiepileptic drugs are tapered. Continuous video-EEG monitoring provides an opportunity to make definitive diagnoses and treatment changes not available from routine, shorter-duration EEG. Video-EEG monitoring is known for the advantages it provides in classifying and characterizing seizures in patients with drug-resistant epilepsy.
In a recent study on seizure classification in a series of patients with absence seizures observed in more than 1,000 video-EEG monitoring sessions, Dr. Tatum and colleagues described a unique type of electroclinical, generalized epilepsy syndrome with polyspike onset absence seizures that had implications for treatment resistance (J Clin Neurophysiol. 2010;27:93-99).
Video-EEG is also considered a gold standard for identifying patients who have received a misdiagnosis of epilepsy. For example, as of June 2010, more than 40% of the patients admitted to the Mayo Clinic in Florida EMU with a diagnosis of epilepsy were found not to have the disease.
In addition, video-EEG is a valuable tool for differentiating epilepsy from events that may be confused with seizures. In the November 24, 2009, issue of Neurology, Dr. Shih and colleagues described a patient who had been given a previous misdiagnosis of Tourette syndrome on the basis of episodes of aggressive, apparent goal-directed gestures and profane verbalization. Video-EEG helped to identify the patient's condition as frontal lobe epilepsy, for which the patient was then successfully treated.
Subtraction ictal SPECT coregistered to MRI (SISCOM), an imaging protocol particularly useful for localization when MRI and EEG are not definitive, is available at Mayo Clinic in Florida. Pioneered at Mayo Clinic in Minnesota, SISCOM subtracts ictal SPECT studies from interictal studies, compares the two images, and coregisters the difference image with the patient's MRI.
Statistical ictal SPECT coregistered to MRI (STATISCOM), a more advanced imaging protocol also developed at Mayo Clinic, compensates for subtle variations among serial SPECT images. It has been shown to localize the seizure focus in more patients with nonlesional MRI findings and to be better at correctly localizing the subtype of temporal lobe epilepsy (eg, mesial temporal, lateral neocortical) than SISCOM (Neurology. 2010;74:70-76). STATISCOM will further enhance the comprehensive evaluation procedures available in the epilepsy center at Mayo Clinic in Florida.
Overall, both Drs. Shih and Tatum agree that among Mayo's most precious resources for patient care are the experienced EEG technologists and dedicated neuroscience nurses who serve the EMU. Together with members of the interdisciplinary team and sophisticated technology and techniques, Mayo Clinic in Florida meets the standards of excellence representative of an NAEC Level 4 Epilepsy Center.