Epilepsy Center – Patient Care and Treatment
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Epilepsy is a disease characterized by recurrent seizures. Seizures occur when the electrical activity of the brain becomes abnormal, resulting in a variety of different symptoms, or seizure types. The location of the abnormal region in the brain and the cause of the seizures determine the types of epilepsy, called syndromes. Individuals with epilepsy may not be able to do many of the things most people take for granted, such as driving, swimming and cooking. They may live in constant fear of the next seizure because they do not know when it will start or what they will be doing when it does. It is our goal to control seizures and improve the quality of life for individuals with epilepsy.
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Epilepsy management begins with an accurate diagnosis. Our skilled and experienced epileptologists usually accomplish this through a detailed history and clinical examination, followed by appropriate tests. Identification of the correct epilepsy syndrome and rapid treatment with the best possible medication can minimize the number of seizures and their impact on a patient’s quality of life. In some cases, patients may have been misdiagnosed with epilepsy and actually have non-epileptic events.
The most common initial diagnostic tests include electroencephalography (EEG) and high-field (3-Tesla or 3T) magnetic resonance imaging (MRI) using a special epilepsy protocol. Some patients may require a 24- to 72-hour ambulatory EEG or inpatient diagnostic video-EEG monitoring. If epilepsy surgery is indicated, we perform a number of additional tests, including video-EEG monitoring.
The Adult Epilepsy Monitoring Unit (EMU) is our dedicated four-bed inpatient unit where patients undergo video-EEG monitoring continuously for several days using state-of-the-art computerized diagnostic equipment. This test records and characterizes seizures. Video cameras located in each room allow epileptologists to analyze the clinical symptoms and signs during seizures, and 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 nurses, technologists and physicians monitor their EEG activity in a dedicated central reading/viewing area.
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 antiepileptic medications, they may be candidates for epilepsy surgery. Video-EEG monitoring is essential to determine the exact region in the brain where the seizures arise in such patients.
Admissions to the EMU are typically scheduled after an initial outpatient consultation in our epilepsy clinic. All scheduled patients should first report to the outpatient EEG lab at the East Campus facility at the designated 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 go to the main hospital for admission to the EMU.
What to Expect in the EMU
- Inpatients stay for four to seven days in a private room with a private bathroom. Invasive monitoring with intracranial electrodes may take 10 to 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 later 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 them to describe any symptoms they are 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. 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.
- An epileptologist will perform a detailed clinical evaluation at the beginning of the stay, analyze and interpret the 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. The patient’s referring physician will receive a detailed written report after discharge. Additional clinical personnel, including resident physicians, nurses and technologists, will also interact with the patient on a regular basis during the stay.
- In order to increase the likelihood of recording events, patients’ antiepileptic medications may be decreased or withdrawn during their stay. The epileptologist will discuss this with them before 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.
- We take the utmost care to ensure patient safety at all times while in the EMU. 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.