MEG Patient Pre-Screening Print E-mail

Patients must confirm/provide the following with the lab before appointments: Complete this form and return to the lab --> MEG Patient Questionnaire

Is this scan for seizures, a brain tumor/lesion, or both?
Is this an urgent referral, i.e. an aggressive brain tumor?
Type(s) of seizures typically experienced: grand mal, cluster, other?
Must not have any metallic braces, cochlear implants, anueurysm clips, or other non-titanium implants
- includes aneurysm clips, dental bridges, steel pins, etc.
(cavities, posts and crowns are usually fine if degaussed)
Are any other conditions/syndromes present? (ADHD/ADD, Developmental delay, Cerebral palsy, or movement disorder, etc.)
Patients should not have taken any narcotic pain killers, muscle relaxants, or benzodiazepines (Ativan, Diastat, Klonopin/clonezepam, Valium) within 24 hours of an epilepsy localization scan.
Have there been any recent medication changes?
The MEG Lab must have a complete list of ALL daily medications for a patient (please see form)
Patients must be able to remain still for an extended period of time.
Vagal Nerve Stimulator implant, pacemaker, or TENS unit?
Prior brain surgery? (Burr holes may cause interference.)