Epilepsy Monitoring Unit (EMU)

INTRODUCTION

You have been scheduled for an evaluation in the inpatient Epilepsy Monitoring Unit (also known as the “EMU”). The goal of this evaluation is to record your typical seizures using a video camera and continuous EEG recording so that your doctor can better treat your seizure disorder. We would like to provide you with information that may make your stay easier for you.

WHY DO I NEED THIS TYPE OF RECORDING?

A traditional EEG lasts about half an hour. It gives us a “snapshot” of the brain’s activity during that particular recording period. This may not be sufficient to give us the information we need to treat your seizures adequately. Inpatient video EEG monitoring will provide us with a more comprehensive picture of your brain activity.

The monitoring process has two components:

1. VIDEO: a camera will record all your physical activity while you are on the EEG. The EEG technologists in the monitoring room will watch you at all times. This way we can detect all seizures that occur during your admission. By videotaping your seizure we can see exactly what happens during one of your seizures. The technologists will also interact with you during and after the seizure to test your speech and awareness. These simple tests help us identify the type of seizure you are having and where in the brain the seizure may be starting. This type of precise seizure evaluation is usually more accurate than any reports you or a family member can give us about your seizures.

2. EEG RECORDING: While in the EMU you will also have a continuous EEG (brain wave) recording. This way we can detect any seizure activity that occurs, even if you are not aware that it is happening. This helps us determine where in your brain your seizures begin so that we can decide just what type of seizure you are experiencing. It also gives us information about how your brain functions between seizures. This type of recording allows us to makes an accurate count of your seizures and to see whether you might have more than one type of seizure.

3. In some cases we will do a test called an ictal SPECT. During this procedure a highly trained technologist will sit at your bedside and wait for a seizure to occur. When the EEG technologist identifies a seizure, the SPECT technologist will inject a small amount of a tracer compound into your vein through an intravenous catheter. This tracer is attracted to the part of your brain where the seizure originates. After a few hours, you will be transported to a specialized scanner in another part of the hospital for imaging of the seizure area. This test, which must be performed right at the time of the seizure, can give us important information about where in the brain the seizure originates.

WHY CAN’T I HAVE THESE TESTS AT MY LOCAL HOSPITAL?

The video/EEG equipment is highly specialized and is not available at most hospitals. Our staff of EEG technologists and nurses is very experienced in caring for people with seizures. Our doctors have advanced training in EEG interpretation and epilepsy treatment. In fact, our EMU has been at the forefront of advanced epilepsy evaluation for more than 26 years. We also have access to a neuropsychologist and other specialists as needed. We believe our Epilepsy Monitoring Unit offers you the best opportunity for receiving a comprehensive and expert evaluation of your seizure disorder.

WHAT CAN I EXPECT?

1) Parking: Please give parking information to the person bringing you to the hospital: Parking is available in the Goodman Street Garage. Please bring in the parking ticket received when entering the garage and present this at the information desk in the main lobby. You will receive a second parking ticket that will allow you to exit the garage without charge. You will need both tickets to exit the garage. There is no parking attendant. The parking garage entrance/exit is automated.

Please note that on the day of hospital discharge, patients are taken down to the Discharge Area by wheelchair. Parking on the day of discharge is available in the lot designated by the sign “Admitting/Discharge.” Please have the person driving you home park in this lot.

2) Directions to the EMU: On the day of admission you will report directly to the EMU on the 4th floor at the time scheduled. Do not go to the admitting office: Enter the main lobby of the hospital. Go to the left of the information desk. The elevators will be on the right. Go to the 4th floor. Follow the sign to 4-East: Epilepsy Monitoring Unit. Stop at the desk on 4-East and tell the receptionist who you are. The staff will be expecting you and will direct you down the 4-East hall to the EMU lab.

3) Your Room: You will have a private room with a phone, cable TV and DVD player. Visitors are welcome during your stay in the hospital. Children are also allowed to visit in your room unless otherwise noted. One adult may stay with you overnight in your room. You will notice that the side rails of your bed are padded. This is for your protection so that you do not injure yourself during a seizure.

4) PLEASE NOTE THAT SMOKING IS NOT ALLOWED ANYWHERE AT THE UNIVERSITY OF CINCINNATI MEDICAL CENTER. We know this can be difficult for some of our patients. It is a strictly enforced hospital policy. We will support you in any way we can. A nicotine skin patch can be ordered if you desire it. We cannot allow you to chew gum, as this will interfere with the EEG reading. Chewing tobacco is also not allowed. Please leave all cigarettes, cigars, pipes, lighters, matches and chewing tobacco at home. Please discuss any concerns you have about this policy with the EMU Coordinator.

5) The epilepsy specialist in charge: While you are in the hospital you will be under the care of a physician who is an epilepsy specialist. This physician will see you daily. In addition, a resident doctor will see you on admission and do a physical and neurological examination. You will be asked questions about your past medical history and your seizures. If you cannot provide this information, please try to bring someone with you, a family member or friend, who can do this. It is especially helpful if the person can provide a description of your typical seizures.

Each day after your admission, the epilepsy specialist will visit and update you on your progress. Ongoing information from the EEG evaluation will be discussed, and you will be informed of what to expect next. Please feel free to ask any questions you have at this time. If family members would like to speak with the epilepsy specialist, you can ask family members to be present when the doctor makes rounds in the morning.

6) Medications: You usually do not need to bring your medicine with you. It will be provided for you. However, we might ask you to bring any special medicine you take, such as eye drops, asthma inhalers or birth control pills. You may also be asked to bring a medication if the hospital does not have it in the pharmacy. Please bring with you a list of your current medicines and their doses. Please list ALL medicines you take, not just those for your seizures.

In order to help you have a seizure, your seizure medications are typically decreased beginning on the day of admission and may be stopped over the next several days if seizures do not occur. For safety reasons, we do not normally reduce your medications prior to your arrival at the hospital. Please take your normal morning doses of seizure medications on the morning of your hospital admission.

7) The video EEG recording: You will have EEG electrodes applied to your scalp, and the technologist will first perform a standard EEG test. Then the electrodes will be connected to a video/EEG monitor. The camera will be turned on and your evaluation will begin. The cable that attaches the EEG wires to the monitoring machine is long enough for you to be able use the bathroom. However, it is very important that you stay on camera at all times.

If you move to sit in a different part of the room, the camera will be adjusted. You will need to tell our nurse if you wish to get up to the bathroom. The EEG technologist or a family member may also assist you. It is necessary for someone to be with you anytime you are out of bed. We realize this can become very frustrating for our patients. Feel free to bring along books, playing cards, puzzles, DVDs and laptop computers — anything you can think of to help keep you occupied.

Our EEG technologists check the electrodes daily and will apply more glue and conducting jelly to ensure a good reading. You will not be able to wash your hair or take a shower until after the monitoring is complete and the EEG electrodes are removed. We suggest that you wash your hair the night before your admission. Please do not use any hair spray, mousse or gels on your hair that day.

At the side of your bed you will find 2 alarm buttons. One is a nurse call button; the other is an “event button.” If you have any warning that you are about to have a seizure, please push the event button. If a friend or family member is with you, he or she can also trigger the alarm if a seizure occurs. Our EEG technologist will explain these to you when you arrive.

When you have a seizure, an EEG technologist will enter the room to closely observe your seizure and do some testing. Your nurse will also be alerted. We do everything possible to prevent injury during seizures.

A capped intravenous line will be placed in one of your veins. This is for your safety. If you have multiple seizures or a very strong one, we can rapidly give you medicine through the intravenous line to stop the seizures. The intravenous line is checked each shift by your nurse to make sure it is working properly. The site where it is placed will need to be changed if it stops working.

Sleep deprivation can also help you to have a seizure. You may be asked to stay up for 21 to 24 hours without sleep or naps. The EEG technologists and/or family members can help you stay awake. When the brain is very tired, it is more likely to have a seizure.

Your privacy will be assured while you are washing up in the morning. You can either use the sink in the bathroom (with a member of staff, a family member or friend seated outside the door in case you have a seizure), or have a pan of water to wash at the bedside. If you wash in bed, we will darken the video screen until you are finished.

While you are in the EMU, you may wear your own shorts, pants, sweat suit bottoms or pajamas, if you wish. However, because we don’t want you to disturb the electrodes, you need to wear tops that button down the front and can be removed without being pulled over your head. We can provide “tie in the back” hospital gowns if you prefer. Basic toiletries are provided, but you may bring your own if desired.

WHEN WILL I GET THE RESULTS OF MY TESTS?

Your epilepsy doctor will visit daily to review your progress. On the day of discharge, your test results will be reviewed with you and your family. If you normally see one of our doctors, you will be given a follow-up appointment at the time of your discharge.

If another doctor referred you to us, he or she will receive a written report of your test results. The epilepsy doctor may also call your doctor to discuss their findings at the time of discharge.

A NOTE ABOUT INSURANCE

We will arrange for pre-authorization for the admission. Please be sure to check your benefits with your insurance company so that you will know which charges are and are not covered by your insurance. Benefits include co-pays, out-of-pocket charges and deductibles. You are responsible for any charges not covered by your insurance. If necessary, our billing office will be happy to help you make arrangements for payment.

IN CONCLUSION

We thank you for choosing the Epilepsy Center at the UC Neuroscience Institute. It is a privilege to be part of your health care team, and we look forward to providing you with our advanced services in the Epilepsy Monitoring Unit. We are committed to providing you with excellent, compassionate diagnostic care that is focused on your individual needs.

If you have any questions about your admission to the Epilepsy Monitoring Unit, please contact our Clinical Nurse Coordinator, Cindy Hughes, RN, at (513) 584-5047.

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