Phase I Monitoring
For many epileptic patients, medication taken properly can control seizures. For other patients, even 2 to 3 medications in combination cannot control seizures. With surgery there is hope for these patients; if the part of brain causing the seizures can be removed, seizures can be stopped.
Why the Epilepsy Monitoring Unit (EMU)?
The purpose of your admission is to assess your condition through monitoring and determine the best treatment. Some types of seizures can be controlled only with medication and other kinds of seizures require a combination of medication and surgery. Monitoring is useful even in some patients not requiring surgery as the brain wave patterns found may suggest that a specific medication is needed. About 20 percent of patients admitted for monitoring will be found not to have epileptic seizures. In these patients seizure medications can usually be discontinued.
To capture brain activity, electrodes are placed on your scalp and then connected to an electroencephalogram (EEG) machine. Once we identify the origin of seizures in the brain, your doctors will have comprehensive data available to assist in designing a treatment program to reduce or stop your seizures. With video-EEG monitoring, we obtain a comprehensive record of brain wave changes occurring during seizures, in a safe, controlled environment. Through monitoring, we can often pinpoint the part of the brain responsible for seizure activity.
You will need to be flexible regarding your appointment date since you may be called in for admission a few days earlier or later than scheduled. If you would like to be monitored as soon as possible, we can place you on our "On Call" list.
The average EMU stay is from 7 to 10 days; however, some patients need as few as 3 days or as many as 14. Your length of stay will depend on how long it takes to get enough information about your condition to make a diagnosis.
What to Bring With You
While you are here, you will be required to remain in bed or in the dayroom; therefore, you should bring appropriate recreational items to occupy your time such as books, knitting, crossword puzzles, etc. The dayroom has a television, a DVD player, and arts and crafts. You may bring handheld video game systems and laptops. Wi-Fi is available. Outside electronics such as hair dryers will need to be checked by our engineering department before use in the unit.
Bring a Friend or Family Member
- You should make arrangements for a friend or family member that has witnessed your seizures to stay with you. You may wish to enlist the aid of more than one person, as someone will need to remain with you 24 hours a day from the time of admittance to your release.
- Your family members or friends will play a vital role in gathering information on your seizures. They will assist the nurses and doctors in recognizing your seizures, in testing your responses during seizures, and in making your stay more pleasant.
What You Should Wear
- Bring plenty of clothing for your stay – enough to last 10 days.
- Because the sensors on your body need to be accessible to the EMU staff, you should wear clothing that buttons up the front. To assist in the video monitoring process, wear colored clothes to provide contrast against the white bed sheets.
- Family members and friends can take laundry home or use one of the nearby laundry services.
For the best possible results during your visit and for your personal safety, we ask that you abide by the following monitoring guidelines:
- For the duration of your stay, you must remain within the range of our monitoring equipment. Your movement is limited to your room and the dayroom; you cannot be monitored in other areas.
- While being monitored, you will not be able to take a shower. This restriction is necessary to avoid any possibility of electrical shock.
- No smoking is allowed in the EMU.
- Visiting hours are from 10 am to 8 pm. If you have children under 14 who wish to visit, please discuss it with the nursing staff.
Phase I Monitoring Schedule
- Upon arrival, you will be given a standard nursing admission assessment including:
- Routine vital signs
- Insertion of a saline lock IV for later medicines and blood work
- Application of electrodes
- Baseline EEG
2nd or 3rd Day
You will receive a positron emission tomography (PET) scan to help locate the area of the brain responsible for your seizures. You will be given, by inhalation or injection, a short-lived, radioactive agent to act as a tracer. You will lie in a scanner that details the metabolism of the tracer in the brain. The amount of the tracer is small, equivalent to a normal X-ray, and is no longer radioactive within a few minutes. The PET scan takes three to four hours.
You may receive a sleep-deprived EEG for which you will need to stay awake for an entire night prior to the procedure. You will have a single photoemission tomography (SPECT) scan, similar to the PET, to detect blood flow changes during seizures. You will be given several neuropsychological tests to assess your language and memory functions. Some patients may have Wada tests performed – an invasive procedure to determine dominant speech and memory areas in the brain.
Many days may be spent just waiting for seizures. As every patient is different, there is no set number of seizures that will be required during the monitoring.
Your last test will be a magnetic resonance imaging (MRI) scan to provide doctors with a cross section picture of your brain. Although you may have had this test before, we use a special technique to reveal seizure-prone areas in the brain.
Getting the Results
The data will be gathered and analyzed and a plan of action formulated. You will be notified when this process is complete; however, it may take several weeks before the final results are available from your doctor.