Left: Alan Ettinger, MD, Right: Max Rudansky, MD

Physicians are commonly confronted with the challenge of making a diagnosis for episodes of loss of consciousness, shaking events, brief changes in mental status, fainting, seizures and spells of extreme changes in emotion. While tests like the routine EEG (electroencephalogram) can be helpful by assessing brainwaves, such tests typically last only 20-30 minutes and are not likely to capture the event in question while the test is running.

Recent advances in brainwave technology however, permit the computerized assessment of brainwave and clinical activity over more extended periods of time, leading to better diagnosis and treatment.

Huntington Hospital, in conjunction with the Comprehensive Epilepsy Center at Long Island Jewish Medical Center, is now leading the way in providing such extended computerized brainwave testing (video-EEG) to Suffolk County, by establishing the new Huntington Hospital Seizure Monitoring Unit.

The system works much the same way as an EEG, with electrodes placed on the scalp, monitoring a patient's brain waves. However, the new system is an extension of the EEG technique, continually recording brain waves for 24-hours a day. The information is sent to a computer where sophisticated software, designed to capture brain patterns, reviews the preceding 24-hour cycle so the clinician can study brainwave and clinical information in great detail.

Alan Ettinger, MD, a nationally known neurologist and epilepsy specialist, currently directs the Long Island Jewish Comprehensive Epilepsy Center and will oversee Huntington Hospital's new program. Dr. Ettinger's active involvement on the national level in teaching and research in this area, will bring the latest diagnostic and treatment techniques to Huntington Hospital.

Huntington Hospital will now also be able to take advantage of multi-disciplinary comprehensive epilepsy services in areas including neuroradiology, neuropsychology, social services, EEG technology, nuclear medicine, psychiatry, and a close working relationship with the Epilepsy Foundation of Long Island.

"Treatment is contingent upon making the most accurate diagnosis," said Dr. Ettinger. "There are a large number of patients with unexplained events; many of these individuals may have diagnoses that have not been fully clarified. Now we can continuously monitor patients to optimize our diagnostic capabilities. This will in turn lead to the best treatments."

Dr. Ettinger explained that there are a wide variety of alterations in consciousness, mood and behavior which may be confused with seizures but represent other types of bodily symptoms, such as changes in cardiac function. In fact, EEG monitoring has frequently been used in conjunction with cardiac monitoring to determine if a cardiac event is responsible for an episode ascribed to the brain.

The new system can study brain waves on a second-by-second basis to permit a detailed analysis. Video-EEG monitoring is also used to help locate where seizures are coming from; an essential test when considering a surgical treatment for uncontrolled seizures.

"This system acquires the signals in digital form so that we can analyze the information in greater detail and look at it in different formats," said Dr. Ettinger. "We will also be able to hone in on a specific portion of the recording to examine it more closely." He noted that the monitoring system is supplemented with video camera recordings that enable the physician to study patient clinical behaviors that coincide with changes in brainwave activity. Technicians trained in the use of the new system will assist in the Seizure Monitoring Unit where patients will be triaged.

The partnership between the LIJ program and Huntington Hospital's Unit will give Huntington Hospital the distinction of being the only hospital on Long Island affiliated with a state-certified epilepsy center. Dr. Ettinger will work closely with Max Rudansky, MD, Chief, Department of Neurology at Huntington Hospital in running the newly established program.

For information contact Dr. Rudansky at (631) 351-1250.

Pictured above -

Left: Alan Ettinger, MD, compares a patient's brainwaves with the new extended EEG technique at the Long Island Jewish Comprehensive Epilepsy Center where he serves as Director.

Right: Max Rudansky, MD, Chief of the Department of Neurology at Huntington Hospital, will work closely with Dr. Ettinger in the newly established program.

JUNE 2000 Healthline