The Epilepsy Monitoring Unit (EMU) at Wolfson’s Children Hospital is a specialized, four-bed inpatient unit designed to evaluate, diagnose and treat seizures in patients of all ages.

EMU Admission

The following steps must be followed before a patient’s admission to the EMU:

1. Typically, patients have an initial outpatient consultation with a neurologist at Nemours Children’s Clinic Jacksonville. If appropriate, an admission to Wolfson Children’s Hospital will be scheduled. All referring physicians receive a report from the patient’s neurologist following discharge.
2. After the admission is scheduled, on the day of admission, all patients must report to the hospital’s main EEG lab at the designated time. The admission process may take two hours or more.

What to Expect While in the EMU

In the EMU, seizures are recorded and studied so that a proper diagnosis can be made and treatment can begin.

1. Patients who take medication to control seizures may have their dosage adjusted or discontinued to increase the probability of seizure activity, providing the opportunity for the activity to be recorded and analyzed. Medication changes will be discussed prior to the patient’s arrival in the EMU.
2. Each patient will have a private room with a private bathroom.
3. Patients will be connected to video and computerized EEG monitoring equipment 24 hours each day. Continuous monitoring is necessary to safeguard patients and gather the necessary information. Patients who want to use a sleep mask should bring a mask that ties at the back of the head.
4. Because the EEG wires are connected to recording equipment, mobility is restricted and patients should expect to spend most of their time sitting in bed or in a nearby chair. In addition, the electrodes will remain on the patient’s head during their entire stay in the EMU, precluding them from washing their hair or showering until the monitoring is completed. Patients may wash at the sink.
5. Patients who experience an aura, a warning that sometimes occurs prior to a seizure, should immediately report this warning to an EMU staff member. The patient’s family members or other visitors should also notify the staff when they suspect a seizure is occurring. By pressing the "seizure button" and verbally describing each occurrence to the staff, the seizures will be recorded on monitoring equipment to help analyze each event. The length of stay in the EMU varies with each patient, depending upon the tests and monitoring required and the number of seizures each patient experiences. Typically, patients stay between three to seven days. After discharge from the EMU, some patients may need to remain in the hospital for a day or two to have medications regulated or re-adjusted.

What to Bring and Wear to the EMU

Patients should bring all current medicines, including non-seizure medications. These medicines will be reviewed upon admission. A nurse will store your medications and return them to you upon discharge.

While patients are in the EMU, they are encouraged to wear their own loose-fitting street clothes (no pullover tops), unless they have been advised otherwise. Patients should bring personal care items, as well as games, books and crafts. A VCR/DVD player is available to patients who bring their own tapes or DVDs.

Parents of young patients may find it helpful to bring special toys or a blanket to help their child feel more comfortable.

Computer-Based Monitoring for Diagnosis

The EMU is staffed with specially trained medical, nursing and technical personnel who observe patients with computer-based monitoring equipment designed to evaluate seizure disorders. Based on this evaluation, treatment options can be determined.

Patients who suffer from seizures that are difficult to diagnose and manage are most likely to be admitted to the EMU. Patients who are being considered for seizure surgery also will be admitted to the EMU for pre-surgery monitoring to identify the exact location in the brain where the seizures originate.

Three surgical diagnostic procedures determine if surgical treatment for epileptic seizures is necessary. These procedures assist a physician in evaluating the cause of a patient’s seizures and locate the origin of the seizures within the brain. After a procedure, a patient remains within the EMU for observation. Surgical diagnostic procedures include:

• Subdural grids: These grids are sheets or strips of electrodes embedded in a thin, flexible sheet of polyurethane. Within the grid are electrode discs made of a platinum alloy. The grids are surgically placed through an open craniotomy (the skull is opened to expose part of the brain), over and around the areas suspected to be linked to a patient’s seizures.
• Subdural strips: These strips are usually used to determine which hemisphere of the brain, or which part of a hemisphere, is the region of seizure onset. They also are used when access to a particular area of the brain may be somewhat limited. When used alone, the subdural strips are implanted through small holes in the skull. After the holes are drilled, the strips are placed using fluoroscopic guidance. After the strips have been placed, the patient is observed for seizure activity in the EMU. The patient also may undergo cortical stimulation, or functional brain mapping, several times, which helps the physician define the relationship between the area causing the seizures and the functional areas of the brain that need to be preserved. Information from this procedure is used to define and plan the second surgery — removal of the strips and, potentially, removal of the area causing the seizures, called the epileptogenic zone.
• Depth electrodes: Small, multi-contact probes are inserted into specified areas of the brain via small holes made in the skull and covering of the brain. The insertion is guided using magnetic resonance imaging (MRI) techniques, targeting a specific area within the brain during surgery. The entry point, trajectory and depth may be calculated by a computer to indicate the precise placement of the electrode. Implanted electrodes are used as a testing method, not a treatment.
• Angiography/Wada test: A patient’s pre-surgical work-up includes this two-part test that is performed to predict the potential impact of surgery on language and memory function. This information is used to determine the best type of surgery and how much brain tissue can be safely removed to preserve areas of the brain associated with speech, memory, and thinking functions.