Seizure Monitoring (Phase I)

Image of doctors looking at EEG monitor

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. An equally important test is a high-definition MRI brain scan. Most patients will have had an MRI prior to their EMU; otherwise an appointment for MRI will be made on discharge. 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 outpatient based  tests (MEG, 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.

Information for Patients

Welcome to our Epilepsy Monitoring Unit (EMU) that is located on the 5th floor (UB57) of our new Neuromedicine Hospital. Your doctor has determined that a multi-day stay in our EMU is the best way of understanding your seizure disorder, so that the best plans for your long-term treatment can be made. On the day of your arrival, you will report to the admissions area in the main foyer of the NeuroMedicine Hospital, and someone will check your medical record, verify your identity and help you find your way to the EMU.

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. 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. 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. 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. Please be assured that you will have IV placed 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.

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. Please do not get out of bed alone. Showers are not permitted though you may take a sponge bath. EEG leads and amplifiers must remain dry at all times. Please do not smoke or chew gum or consume hard candy. If you need a nicotine patch, please ask and you will be provided one. For your safety, we provide non-skid grip socks.

Prior to discharge, and depending on the results obtained, you may have more tests organized as an outpatient (e.g. PET, fMRI, MEG, Wada). 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.

Always feel free to email or call us with questions and clarifications at, (352) 273-5552