Seizure Monitoring (Phase I)

Seizure monitoring is a crucial investigation for certain patients with epilepsy or suspected epilepsy. In essence, seizure monitoring is the direct observation of the patient’s symptoms by the treating team – observation by video and EEG. Data gathered from EMU testing informs the team – the epileptologist (attending/ faculty neurologist who specializes in epilepsy), the nurse practitioner, rotating neurology residents and fellows, nurse coordinators,and EEG technologists – about the type of spell the patient is experiencing. The patient’s symptoms are thoroughly understood first-hand in this manner, and appropriate management plans are made. Patients generally stay for 3-5 days, and anti-seizure medication are usually weaned and/or discontinued to provoke the occurrence of spells.
For patients with medication resistant epilepsy who may be candidates for epilepsy surgery, EMU evaluation is a mandatory procedure – often called ‘Phase I’ evaluation – that informs the treating team about the brain area that is producing seizures and how those seizures spread. Pre-surgical patients also undergo neuropsychological testing while they are admitted to the EMU; sometimes neuropsychological testing is performed after discharge as an outpatient. Together with the results of other tests (MRI, PET etc.) the treating team is able to identify whether the patient will benefit or from surgery, and whether still further tests are required to make that determination. These decisions are made at the conclusion of the patient EMU stay and occur at our weekly multi-disciplinary epilepsy patient management conference.

 

The Epilepsy Management Conference (EMC)

More information to come…

Additional Tests for Epilepsy Surgery Patients

More to come…

Positron Emission Tomography (PET) Scan – A PET scan is used to localize the part of the brain that is causing the seizure activity. It provides additional information to confirm seizure focus that may or may not have been seen on EEG. This scan is done by injecting a small amount of radioactive (tracer) into the vein. Then pictures are taken of the brain’s metabolism to identify where the seizure focus. This test takes about 2 hours.

Functional Magnetic Resonance Imaging (fMRI) – A fMRI is similar to a regular MRI except you are given simple activities/commands like finger tapping, toe tapping, reading a passage from a book, etc. While doing these activities, this study will map out important functions such as speech and movement.  Creating this map will help doctors better understand the regions of the brain linked to critical functions such as speaking, walking, sensing, or planning. This test takes 1-2 hours.

Neuropsychological Testing – A neuropsychologist will administer a test that measures areas such as attention, problem solving, memory, language, I.Q., visual-spatial skills, academic skills, and social-emotional functioning. This test is helpful in locating the part of the brain that may not be performing its function well and that also may be causing the seizure activity. This test takes 4-5 hours.

Magnetoencephalography (MEG) Scan – A MEG scan measures the small electrical currents or magnetic signals from the brain and pinpoint the abnormal brain activity. The scanner, used to detect and amplify magnetic signals produced by the brain, does not emit radiation or magnetic fields. This is a non-invasive study. This test takes 3-4 hours.

Wada Angiogram – The left and right hemispheres of the brain are responsible for different functions. A Wada test is performed to map out memory and language. During this test, one-half of the brain is put to sleep for 2-3 minutes using a short acting medication called Brevital. This medication is given through a catheter inserted in the femoral artery in the groin. The awake half of the brain is tested for language, memory, and learning function. You will be asked to remember pictures and objected shown prior to the injection of Brevital. You will also be asked to squeeze a ball that measures your strength. When testing is completed on the one side of the brain, then the other side will be tested in the same manner. EEG monitoring is also being recorded to observe brain activity during Wada testing

Information for Patients

Our Epilepsy Monitoring Unit (EMU) is located on the 5th floor (UB57) of our new Neuromedicine Hospital.

  • Each monitoring room has special seizure-monitoring equipment and ceiling-mounted cameras. All monitoring rooms are private rooms.
  • This is a 3-5 day admission. There are times your admission may be a little longer depending on how long it takes to record seizures. We typically like to record at least 3 seizures.
  • The nursing staff will orient you to your room and will explain the use of the nurse-call system, seizure monitoring equipment and information about the hospital routine.
  • A detailed history of your seizures will be obtained by the doctors, nurses, nurse practitioners and/or EEG technicians.
  • You may have lab work at the time of admission, and further lab tests as necessary during your stay.
  • During your stay the team may also request a neuropsychological evaluation to better understand your brain function and its relation to your symptoms, This is a paper and pencil test that evaluates language, memory and other mental functions.
  • We try to create the best environment to record seizures to include slowly tapering seizure medications.
  • During your stay, you may be sleep deprived. This is another way to provoke seizures.
  • You will have IV access should we need to give fast-acting medications to control seizures; side rails of your hospital bed will be padded to prevent possible injury during a seizure.
  • Video-EEG monitoring is continuous. EEG leads are checked daily.
  • The epilepsy team will make rounds daily, when you will have the opportunity to ask the team about the information gathered in the prior 24 hours.
  • We recommend having a companion stay with you during your hospitalization, however, if you do not have someone to stay with you, a bed alarm will be used for your safety. You will need to call your nurse for assistance using the bathroom. You are not allow to get out of bed alone.
  • You are permitted to take a sponge bath. EEG leads and amplifiers must remain dry at all times. Showers are not permitted.
  • No smoking or chewing gum. No hard candy. All potential risk for aspiration.
  • You will need to wear non-skid grip socks (provided for each patient).
  • Prior to discharge, and depending on the results obtained, you may have more tests organized as an outpatient (e.g. PET, fMRI, MEG, Wada). Some of these are detailed above.
  • You would normally follow up in the outpatient clinic with the doctor who requested the EMU testing. This will be a further opportunity for you to discuss the results obtained, and what those mean for the treatment of your condition.