Epilepsy Monitoring Unit

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Epilepsy Monitoring Unit

The Epilepsy Monitoring Unit .. EMU
will help your doctor decide if the spells that you are
having are seizures



If you do have seizures, the EMU can help determine the type of
seizures you are having
The EMU can also help your doctor decide if you are able to have
epilepsy surgery


Frequently Asked Questions


? What patients are appropriate for the EMU

Patients that have new onset seizure disorder can be monitored
This allows classification of the seizure type and will
guide further therapy and treatments

Any patient with unexplained loss of awareness can be monitored
This includes seizures, but also, fainting spells (syncope)
severe dizziness, events of memory loss (amnesia)

? Is this a risky test

There is some risks involved and a procedure consent
form is signed by the patient (or guardian)
The risks include all of the usual risks associated with having
a seizure or severe fainting spell
The risks include injury to muscle, bones, or nerves
head injury, even death

However, the testing is done in a very controlled environment
with continuous monitoring by video and with a nurse very close by
The attending neurologist is on call 24 hours per day for the EMU
The EMU monitoring is considered worth the risks listed
above because uncontrolled seizures (outside of the hospital) have
the same risks and it is imperative to find out about the seizures
so to provide better care for the patient

I am only having one or two seizures per year
? Is this really necessary

The standard of medical care for an epilepsy patient at this time
is "No seizures and no side effects" if possible
Therefore, a few seizures per year is considered uncontrolled
and every effort is made to improve this seizure frequency (if possible)
The EMU is the "gold standard" for diagnosing seizures and epilepsy

? How many seizures will I have while in the EMU

The convention is two obtain video and EEG data
on five seizures or typical events

I had an EEG test as an out-patient in the past
? Why can't we just use that information

This is a very good question and the answer is statistical
A 20 to 40 minute EEG is able to capture the abnormal brain waves
about half of the time in a seizure patient

The long term monitoring EMU testing has better
sensitivity of 95% or higher
That means that if there is an epilepsy disorder the EMU testing
will find this out 95% of cases and miss the correct diagnosis
only 5% of cases





Will my anti-antileptic drugs be changed
? or stopped while in the EMU

Most of the time, AEDs will be reduced or even stopped
This allows the untreated brain activity to be recorded
by the EEG computer
If no seizures (or spells) occur while in the hospital, some data
is still found useful but actual seizure events are
the key information that is to be collected


? Why is prolonged video/EEG monitoring required

A traditional EEG lasts about a half hour
It gives us a "snapshot" of the brain’s activity
during that particular recording period

This may not be sufficient to give us the information
we need to treat your seizures adequately
: Our recording has two components

VIDEO: A camera will record all your physical activity
while you are on the EEG
The EEG technologists in the monitoring room
will watch you at all times
This way we can detect all seizures that occur during your admission
By videotaping your seizures we can see exactly what happens
during one of your seizures

This is usually more accurate than any reports you or
a family member can give us about your seizures
All of our technologists and nurses are specially trained in recognizing
and responding to seizures, to maximize your safety

EEG RECORDING: While in the epilepsy monitoring unit (EMU)
you will also have a continuous EEG recording
This way we can detect any seizure activity that occurs
even if you are not aware it is happening
It helps us determine where in your brain your seizures begin
so we can decide just what type of seizure you are experiencing
It also gives us information about how your brain functions
between seizures. This type of recording allows us to make
an accurate count of your seizures and to see if you might
have more than one type of seizure

? Why can't I have these tests at my local hospital

The video/EEG equipment is very specialized and
not available at most hospitals
Our staff of EEG technologists and nurses are very experienced
in caring for people with seizures
Our doctors have advanced training in EEG interpretation
and epilepsy treatment
We also have access to a neuropsychologist and
other specialists as needed
We feel our Epilepsy Monitoring Unit offers you the best
opportunity for receiving a comprehensive and expert
evaluation of your seizure disorder

? What can I expect in the epilepsy monitoring unit

While you are in the hospital you will be under the care of
and seen daily by one of our physicians who is an epilepsy specialist
In addition, a resident doctor will see you on admission and do a
physical examination with added neurological tests
You will be asked questions about your past
medical history and your seizures
If you cannot provide this information, please try to bring
someone with you, a family member or friend, who can do this
It is especially helpful if the person can provide a description
of your typical seizures
You will have EEG electrodes applied to your scalp and
the technologist will first perform a standard EEG test
Then the electrodes will be connected to a video/EEG monitor
The camera will be turned on and your evaluation will begin
The cable that attached the EEG wires to the monitoring machine
is long enough for you to be able to use the bathroom

However, it is very important that you stay on camera at all times
At the side of your bed you will find 2 alarm buttons
One is a nurse call button and the other red one is called an event button
If you have any warning about your seizures, please push the event button
If a friend or family member is with you, he or she, can also trigger
the alarm if a seizure occurs
We also ask you to keep a diary of any unusual feelings
of seizures you can remember

Our EEG technologist will explain these to you when you arrive
When you have a seizure an EEG technologist will enter the room
to closely observe your event and do some testing
Your nurse will also be alerted
We do everything possible to prevent injury during seizures
Special thin wires called sphenoidal electrodes may be inserted
These are placed under the skin just above the jaw
with a small needle which is then removed
These electrodes give us more information about
seizure activity in the temporal lobes
It is normal for your jaw to feel sore for about
a day after they are inserted

All patients see our neuropsychologist and have neuropsychological
testing during the first few days of monitoring
These written tests give us information about your brain functioning
and may show areas that are affected by seizure activity
This testing takes about three to four hours

Your antiepileptic medicines may be decreased or stopped
while you are in the hospital
We do this to try to bring on seizures
We do not usually reduce medications prior to your admission
A capped intravenous line will be placed in one of your veins
This is for your safety. If you have a lot of seizures or a very strong one
we can rapidly give you medicine in the intravenous line
to stop the seizures
This intravenous line is checked every shift by your nurse
to make sure it is working properly
The site where it is placed will be changed every few days
It will also be changed if it stops working
We might sleep deprive you to try to bring on a seizure
This means you would stay up for 24 hours without sleep or naps
When the brain is very tired, it gets irritable and is more likely
to have a seizure

Every day your doctor will visit and update you on your progress
We will discuss what information we have gathered so far and let you
know what to expect next
Please feel free to ask any questions you have at this time
We will also make arrangements to talk with your family during your admission
You will have the opportunity to learn more about epilepsy
and its treatment. Our nurse clinician will meet with you
and your family to discuss any questions you might have
We have videotapes and pamphlets that can provide
you with more information about epilepsy


? When will I get the results of my tests

Your doctor will visit daily to review your progress
We will usually discuss with you a plan of action before
you are discharged if the results of all tests are available
If you normally see one of our doctors, you will be given
a follow-up appointment at the time of your discharge
At that time we will formally review all your test results
with you and your family

If you were referred to us by another doctor, he or she will receive
a written report of all your tests shortly after you have been discharged
Sometimes our doctors also call your doctor to discuss our findings
at the time of discharge. Our report will include recommendations
for care of your seizure disorder
You will need to discuss these results with your doctor


? Am I a candidate for epilepsy surgery

The initial evaluation for epilepsy surgery begins with admission
to the epilepsy monitoring unit to record seizures
You will be admitted to University Hospital, where your physical movements
and brain activity will be monitored around-the-clock by videotape and electroencephalogram
In this way, we are able to locate seizure-triggering areas in the brain
Other testing that is used includes MRI, PET and SPECT scans
We recommend surgery only when we can be certain
that the area of seizure activity in your brain can be removed
without undue risk to normal brain function





: We offer several procedures for surgical treatment of seizures

Temporal lobe resection
Frontal lobe resection
Corpus callosal section
Extratemporal resection
"Lesionectomy"
Vagal nerve stimulator

Some patients require invasive electrode monitoring (phase II) where
small electrodes are inserted into brain tissue, or electrodes
are placed directly on the brain surface
These procedures are performed if it is uncertain where seizures
arise in the brain or if the seizure-producing brain tissue is close
to important functional areas of the brain
such as motor control or speech and language centers
The decision to perform surgery is made only after a thorough
discussion of a patient's case at the epilepsy surgery conference

The results from epilepsy surgery are very favorable
however, each individual's chance of improving with surgery
differs and your physician will discuss with you what your particular
chance of becoming seizure-free is, and what the potential
risks for surgery are in your particular case


:D


OrjoWan



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