Seizure Monitoring (Phase I)

Phase I – Epilepsy Monitoring Unit (EMU)

Adult patients are admitted to our Epilepsy Monitoring Unit (EMU) for video EEG monitoring at the Neuromedicine Hospital, Floor 57. Each monitoring room has special seizure-monitoring equipment and ceiling-mounted cameras. All monitoring rooms are private rooms.

What to expect during your hospital stay

  • 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.
  • The side rails of your hospital bed will be padded to prevent possible injury during a seizure.
  • 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 to bathroom. You are not allow to get out of bed alone.
  • Video-EEG monitoring is continuous. EEG leads are checked daily.
  • 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).
  • You will have IV access should we need to give fast-acting medications to control seizures.
  • 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.
  • A detailed history of your seizures will be obtained by the doctors, nurses, nurse practitioners and/or EEG technicians.
  • Lab work at the time of admission.
  • The epilepsy team will make rounds daily.
  • Prior to discharge, you will have a brain MRI done to evaluate for structural abnormalities.

Based on the findings during Phase I monitoring, more information may be needed in order to identify a single seizure focus. This would require further testing. Other tests may include a PET Scan, Functional MRI, Neuropsychological Testing, MEG Scan, and/or Wada Angiogram.

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.

Epilepsy Management Conference (EMC)

Patients who are considered surgical candidates for epilepsy surgery, will have their case presented by the medical team at Epilepsy Management Conference. This weekly conference consists of a team of epileptologists, neuroradiologists, neuropsychologists, and neurosurgeons. During this conference, there is a detailed review of the patient’s seizure history, EEG, brain MRI and neuropsychological testing. After the clinical data is reviewed by the conference medical team, it is determined by the medical whether or not the patient continues to be a surgical candidate. If the patient is deemed a surgical candidate, a consult is requested to Neurosurgery for Phase III.

Oftentimes more information may be necessary for seizure localization, language and motor mapping. In this case, more testing is required to include Wada angiogram, PET scan, MEG scan, and/or functional MRI. Once these tests are completed, this data is represented at EMC to determine the patient candidacy for seizure surgery.