Epilepsy Monitoring Unit
The gold standard for diagnosis and treatment of epilepsy is the Epilepsy Monitoring Unit (EMU). St. David’s North Austin Medical Center currently has a 4-bed EMU, with planned expansion to a 6-bed unit in 2011.
In the EMU, state-of-the-art digital Video-EEG recording equipment evaluates epilepsy patients. The continuous and simultaneous video and EEG recording allows the physician to capture a patient’s habitual seizure and thus determine the type of seizure and specific site of its onset within the brain.
Simultaneous video recording captures clinical changes associated with the seizure, which is helpful in analyzing the data and determining seizure type. Data analysis is enhanced by capturing subtle clinical changes during a seizure, such as arm posturing, arm movement or head turn, as well as the time frame in which these changes appear relative to electrographic changes on the EEG.
Data collected through this process is utilized to prescribe the most appropriate treatment option.
Who benefits from an EMU?
The EMU is beneficial for persons with known epilepsy as well as those who have neurological conditions that mimic epilepsy such as complicated migraine, recurrent TIA, sleep disorder, anxiety and panic attacks, cardiac arrhythmia, and syncope.
The evaluation is particularly beneficial for patients considering epilepsy surgery, as well as those with status epilepticus or those in need of medication adjustment. The EMU allows for adjustment of antiepileptic medication in a safe environment.
The EMU Process
On the day of admission, patients first report to the admission desk before meeting with EEG staff for electrode application. Using quick-dry glue and a hair dryer, approximately 22 electrodes are applied to the scalp in a non-invasive procedure. Occasionally, special electrodes such as sphenoidal electrodes, may be used. The special electrodes are applied by the physician after receiving patient consent.
If seizures do not occur during monitoring, anti-epileptic medications are reduced or discontinued temporarily. Other activation procedures, such as staying up late or hyperventilation and photic stimulation, may also be used.
The usual length of stay in the hospital is three to five days; however, some cases such a pre-surgical evaluation, status epilepticus or uncontrolled seizures, may require a stay of seven to 10 days.
Patients stay in private rooms equipped with DVD players, flat screen televisions and wireless Internet. Each room has a sleeper next to the bed, as family members are encouraged to stay with the patient during monitoring.
To achieve the best possible outcome, the epilepsy program offers other diagnostic tests and procedures that complement Video-EEG monitoring, including:
- SPECT Scan
- Brain Mapping
- MRI, MR Spectroscopy, CT, PET
- Wada test
- Sphenoidal Electrodes placement.
Available treatment options include:
- Treatment with Antiepileptic medications
- Enrollment in clinical trials
- Intracranial Grid and strips placement for monitoring
- Vagal Nerve Stimulation
- Corpus callosotomy
- Multiple Subpial Transections