Epilepsy Monitoring Unit (EMU)

The Adult Epilepsy Monitoring Unit (EMU) at Penn State Milton S. Hershey Medical Center consists of a dedicated four-bed inpatient unit where patients undergo video-EEG monitoring continuously for several days using state-of-the-art computerized equipment. The purpose is to record and characterize the seizures experienced by patients. Video cameras located in each room allow epilepsy specialists to analyze the clinical symptoms and signs during seizures. EEG electrodes provide information about changes in the electrical activity of the brain during and in between seizures. Throughout their stay, patients are closely observed, and their EEG activity is monitored by nurses, technologists, and physicians in a dedicated central reading/viewing area as well as at another location at the East Health Campus facility.

There are two main reasons for admission to the EMU—diagnosis and surgery.

Diagnosis: Patients may sometimes have recurrent events, but a diagnosis of epilepsy cannot be clearly established or disproved based on the clinical symptoms, routine or ambulatory EEG, and brain MRI. Recording the events themselves and analyzing the clinical symptoms and electrical activity during the events can help establish a definitive diagnosis. Sometimes, patients may have both epileptic seizures and other spells that look like seizures. Video-EEG monitoring can distinguish between the two types.

Surgery: When patients have epileptic seizures arising from one side of the brain and they are not controlled with two or more medications, they may be candidates for epilepsy surgery. Video-EEG monitoring is essential in such patients to determine the precise region within the brain where their seizures originate.

Admissions to the EMU are typically scheduled after an initial outpatient consultation in our epilepsy clinic. All scheduled patients should initially report to the outpatient EEG Lab at the East Health Campus facility at the instructed time on the day of admission for attachment of electrodes. Physicians may perform a detailed clinical evaluation at this time or after admission to the hospital. Patients will then proceed to the main hospital for admission to the EMU. Invasive monitoring requires admission to the EMU, placement of intracranial electrodes in the operating room by your epilepsy neurosurgeon, and transfer to the EMU for monitoring after 1-2 days.

• Inpatient stay for 4-7 days in a private room with a private bathroom. Monitoring with intracranial electrodes may take 10-14 days. Length of stay varies from patient to patient, depending on the tests and monitoring required and the number of seizures experienced.

• An event or seizure button is provided. Patients who experience auras or can otherwise tell when their seizure is starting should press the button as soon as possible after onset. This is recorded and assists with the analysis of events. It also alerts the staff that a seizure or event is starting.

• Trained personnel observe and interact with patients during an event. They may ask the patient to describe any symptoms they may be experiencing, test their level of consciousness, and perform a clinical examination.

• Patients will be able to move within the room and go to the bathroom, but cannot step out of the room, as the EEG wires are connected to the equipment and video cameras cannot monitor activities outside the room. Patients will not be able to shower or wash their hair until monitoring is completed and the electrodes are removed.

• A specially-trained physician, called an epileptologist, will perform a detailed clinical evaluation at the beginning of the stay, analyze and interpret their study on an ongoing basis, discuss the video-EEG findings with the patient at least once a day, and provide a summary of the evaluation at the end of the hospital stay. A detailed written report will be sent to the patient’s referring physician after discharge. Additional clinical personnel including resident physicians, nurses, and technologists will also interact with the patient on a regular basis during their stay.

• In order to increase the likelihood of recording events, the patient’s antiepileptic medications may be decreased or withdrawn during their stay. This will be discussed with them by the epileptologist prior to making any changes and the exact approach will be individualized. Additional standard methods such as sleep deprivation, hyperventilation and intermittent flashing lights (photic stimulation) may also be used.

• At all times during the stay, we will take the utmost care to ensure the patient’s safety. Medications will be restarted a day before discharge or earlier if there are several seizures over a short period of time. If necessary, medications may be given intravenously.