Phase I and Phase II Monitoring

The purpose of phase I and phase II monitoring for patients with epilepsy is to assess your condition and determine the best treatment.

Through monitoring, we can often pinpoint the part of the brain responsible for seizure activity. 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.

For many epileptic patients, medication taken properly can control seizures. For other patients, even 2 to 3 medications in combination cannot control seizures. For them, surgery offers hope. In epilepsy surgery part of the brain causing the seizures can be removed, controlling and eliminating future seizures.

Monitoring is even useful 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.

Epilepsy Monitoring Unit

Phase I and phase II monitoring are done in the Epilepsy Monitoring Unit (EMU). 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 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 Expect During Your EMU Stay

What to Bring

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:

  • Books
  • Knitting
  • Crossword puzzles
  • Handheld video game systems
  • Laptops

The dayroom has a television, a DVD player, and arts and crafts. Free 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 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.

Family and Friends

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 1 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.

Monitoring Restrictions

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. However, you may take sponge baths.
  • 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

Day 1

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

Day 2 or 3

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 3 to 4 hours.

Remaining Days

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.

Final Day

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.

Phase II Monitoring

If data collected during your phase I admission does not provide your physician with enough information to determine whether you would be a good surgical candidate, phase II monitoring may be needed.

Phase II Monitoring Schedule

Upon arrival, you will be given a standard nursing admission assessment similar to phase I. Some patients may have Wada tests performed – an invasive procedure to determine dominant speech and memory areas in the brain.

Once the preliminaries are finished, you will have surgery to place strip grids and depth electrodes into your brain to receive clearer, more accurate information regarding your seizures.

Strip grids consist of parallel rows of electrode contacts and are placed on the surface of your brain. Depth electrodes are inserted into the brain to reach deep recording sites. Both provide more accurate information as to the location of epileptic focus.

After a brief period in the recovery room, you will return to the EMU. You will spend the next day or two recuperating. When your recuperation is complete, the electrodes will be connected to the EEG monitoring equipment to record your brainwave activity.

In order to provoke seizures, we may reduce or discontinue your current medications. Do not discontinue your medications unless directed to do so.

After connecting to the EEG equipment, we will wait for your seizures to occur. Each seizure will be analyzed and decisions regarding your care will be made. You will be kept informed as this dynamic process develops. Once enough information has been gathered, a conference will be held with your epilepsy team. At this point you may stay and have the surgery or you may have the electrodes removed and go home without the surgery.

If you do undergo surgery you should expect a recovery period anywhere from 3 to 5 days. We will make all efforts to have your post-surgical recovery in the EMU.

Additional Monitoring Guidelines for Phase II

Many of the guidelines are the same that you experienced during your phase I admission. In addition to these, you may experience more limitations for protection of the indwelling electrodes. You may be required to remain in your bed, or in some cases, soft restraints may be applied. You will be included in these decisions as we attempt to monitor your safety.

Comprehensive Epilepsy Center

As a Level IV Epilepsy Center, our team of doctors, nurses, EEG technologists and psychologists provides the highest level of patient care and offers the widest array of epilepsy treatment programs available. The Center is internationally recognized for the diagnosis and effective treatment of epilepsy.