Epilepsy Monitoring Unit (EMU)

A.  What is an Epilepsy Monitoring Unit (EMU?)

This is a specialized unit in the hospital where a patient is admitted for 3-5 days for continuous monitoring of brain activity using EEG and Video.  This gives your doctor a better understanding of your seizures by seeing how your brain functioning and what you are physicially doing during the event.

B.  Why am I being admitted to the EMU?

The EMU is used to record abnormal brain activity during seizures that could not be recorded with the regular 20 minute EEG or Ambulatory EEG (aEEG). As the study is performed in controlled setting of the hospital, the physician can lower or stop your seizure medications to increase chance of rfecording seizures during the study. This allows the epileptologist to have a very comprehensive understanding of your seizures.

This test can also be used if you continue to have seizures after trying different medications and to confirm or rule out the diagnosis of epilepsy and also to help locate the part of the brain where seizures start.

The monitoring has 2 components:

  1. Digital Video Recording: A camera will record all of your physical activity while your are having your EEG recorded.  There will be an EEG Technologist in the monitoring room at all times to watch you and record any events during your stay.  The technologist will also interact with you during and after an event to test your speech, memory and response to specific questions.  These simple things will help us to identify the type of event and where in the brain it has occurred.
  2. EEG Recording:  While in the EMU you will have continuous EEG (brain waves) recorded.  This will allow us to see any abnormal brain patterns that happen, even if you are unaware they are happening.

In some cases we will do a test called Ictal SPECT scan.  This will be performed just like a regular EMU admission, but a specialized tech will be at your bedside and wait for an event to occur.  When an event is identified, the technologist will inject a small amount of the tracer compound into your vein through an IV (intravenous).  The tracer is attracted to the part of the brain that is causing theseizure.  You will then be transported to another department with a specialized scanner for an imaging study.  This will give us very important information as to where the seizure originated in the brain.   

C.  How do I prepare for the EMU Admission? 

To prepare for an EMU Admission:

  • Wash your hair the night before or the day of the test, but don't use any conditioners, hair creams, sprays or styling gels. Hair products can make it harder for the sticky patches that hold the electrodes to adhere to your scalp. If you have weaves or braids, they may need to be removed before a test can be completed.
  • Wear loose fitting clothes
  • Follow your physician’s instructions regarding your medication.
  • Arrive at your scheduled time, delays can occur if you are late
  • You may bring electronics (laptop etc...) to use during your stay.
  • Internet and cable are provided.
  • Please be sure your transportation is set up to and from the hospital
  • Visitors are allowed during your EMU admission and a family member or loved one who is familiar with the seizure is encouraged to stay with the patient.

D.  What to Expect During your EMU Visit?

Here is what you can expect during an EMU Admission:

  • In order to help you have a seizure or event your medications are typically reduced prior to or the same day of your admission (Follow Doctors Instructions). 
  • A technician measures your head and marks your scalp with a special pencil, to indicate where to attach the electrodes. Those spots on your scalp may be scrubbed with a gritty cream to improve the quality of the recording.
  • A technician attaches flat metal discs (electrodes) to your scalp using a special adhesive. Sometimes, an elastic cap fitted with electrodes is used instead. The electrodes are connected with wires to an instrument that amplifies — makes bigger — the brain waves and records them on computer equipment.

Once the electrodes are in place, your head will be wrapped with gauze to help keep the electrodes in place during your EMU Admission.

The recorder device is attached to a strap that will go around your neck and the wires can be worn inside or outside of your clothing.  The video will record 24 hours a day.  The video will not follow you into the bathroom. 

  • If you move to sit in a different part of the room, the camera will be adjusted.  Please let a nurse or the technologist know when you need to use the rest room.  A family member or nurse can assist you to the bathroom. 
  • Our EEG Technologists check the electrodes daily to reapply or fix them as necessary.  You will not be able to wash your hair or shower during your EMU admission.
  • At your bedside you have a nurse alarm and an event button connected to the EEG Equipment.  If you feel like you are going to have a seizure, "Push the Event Button".  If your event happens suddenly, a family member can press the button for you.  The technologist will go over these steps with you when you arrive.
  • During an event, a technologist will come to your room immediately to keep you safe, observe the event and alert the nursing staff.  The nursing staff will come into the room and perform their assessments (blood pressure, oxygen level, etc..)
  • Sleep deprivation (staying awake for 24 hours), hyperventilation (breathing exercise), photic stimulation (strobe lights) may be used to help induce an event.  Whenever your brain is tired, it is more likely to have an event.
  • During your hospital stay an EMU physician who is specially trained in EEG/Epilepsy will be responsible for your care and will be reviewing your video-EEG recording daily and will see you daily along with the EEG/Epilepsy fellows and neurology residents.Typically, the physician would like to record several of your seizures to properly diagnose type and location of seizures. The EMU physician will let you know how many seizures are needed.

E.  How do I get my results?

After your EMU admission, the technician removes the electrodes, your study will be downloaded to our secure server for the physician specializing in EEG/Epilepsy to read.  Results are generally available a week after your admission.  The results will be sent to the physician that ordered the study.