Epilepsy Monitoring Unit

The Epilepsy Monitoring Unit (EMU) at Children’s Memorial Hermann Hospital plays a crucial role in the comprehensive care and evaluation of patients with seizures. It is especially instrumental in addressing children with intractable or drug-resistant epilepsy, a condition characterized by persistent seizures despite the use of multiple antiseizure medications.

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As part of the Children’s Neuroscience Center, the primary purpose of our EMU is to closely observe and record seizure activity using Video-Encephalography in a controlled environment. This allows health care professionals to gather detailed information about the frequency, duration and characteristics of seizures. By doing so, the EMU helps the team in determining an accurate diagnosis, classification of seizures and treatment plan for patients with epilepsy.

Inside the EMU

Our EMU is a specialized 6-bed facility equipped with state-of-the-art technology and staffed by a team of trained health care professionals including, but not limited to, nurses and EEG technologists. It provides a safe and controlled environment for continuous monitoring of patients with epilepsy. The unit typically includes monitoring rooms with video surveillance and electroencephalogram (EEG) equipment to capture real-time brain activity during seizures. Additionally, there is round-the-clock care, ensuring the safety and well-being of patients throughout their stay. The nursing station is equipped with monitoring screens to observe patients continuously while they are in their rooms. Furthermore, there is a dedicated EEG tech room where EEG technicians are stationed around the clock. In this room, they have monitoring screens that display both the video and EEG data of each patient.

From confirmed intractable epilepsy to extended monitoring or invasive procedures, evaluations cover a rangeIs of scenarios.

• Phase 1 evaluation of patients with intractable epilepsy: This evaluation focuses on patients with intractable epilepsy unresponsive to two or more anti-seizure medications. By understanding the patient’s epilepsy type and seizure characteristics, our team develops a comprehensive treatment plan. This may include exploring non-medication approaches like ketogenic diet, vagal nerve stimulator, or assessing eligibility for epilepsy surgery.
• Phase 2 Stereo EEG Evaluation: This is an invasive evaluation where electrodes are placed inside the brain tissue through holes in the skull. This evaluation provides a more detailed localization of the onset of seizure activity, in preparation for the patient undergoing invasive surgical procedures to remove or modify the area of the brain where seizures start. The same seizure capture and characterization process done in Phase 1 is followed after the placement of the electrodes.
• 23-Hour EEG Outpatient Studies: Patients stay in the EMU for 24 hours, observed through video and EEG, while remaining on medications. This test helps characterize seizures, particularly for those without a confirmed epilepsy diagnosis.
• Capture and Characterize Admission (inpatient): Patients requiring more than 24 hours, but not necessarily having intractable epilepsy are admitted as inpatients. The attending physician adjusts the daily care plan in discussion with the patient and family on rounds. This evaluation captures and characterizes events on the EEG and video over an extended period, aiding in understanding the type of epilepsy or events the patient is experiencing, and in designing or modifying an individualized treatment plan.
• Provocation and Trigger Testing: In some cases, patients, especially those with invasive electrodes or intractable epilepsy, often have their medications adjusted or withheld. Techniques like sleep deprivation, Benadryl® or Tramadol® administration, and exposure to known triggers like exercise or emotional stress, are used to induce and capture seizures. This approach helps enhance the understanding of the patient’s seizure threshold and triggers, and maximize the efficiency (and decrease the length) of their inpatient stay.

From Evaluation to Developing a Treatment Plan

The information gathered during monitoring serves as a foundation for creating individualized care plans for patients with epilepsy. By analyzing the data on seizure frequency, duration and patterns, our team can tailor treatment strategies to meet the unique needs of each patient.

Individualized care plans may include medication adjustments, lifestyle recommendations, and, in some cases, surgical interventions. The goal is to optimize seizure control while minimizing side effects and improving the patient’s overall quality of life. Regular reassessment and adjustments to the care plan ensure effectiveness and adaptability to the patient’s condition.

Care within our EMU is characterized by a multidisciplinary approach involving a diverse team of health care providers. Affiliated neurologists, epileptologists, nurses, EEG technologists and other medical team members collaborate to provide comprehensive care. This team works together to evaluate the patient’s medical history, conduct diagnostic tests and interpret the data collected during monitoring. The multidisciplinary approach ensures a holistic understanding of the patient’s condition and enables the creation of tailored treatment plans. After Phase 1 and Phase 2 evaluations in the EMU, all of each patient’s results are presented in our weekly Epilepsy Patient Management Conference, where all the team members above, as well as affiliated neurosurgeons, radiologists, and pediatric MEG specialists, participate in reviewing the data, discussing options and formulating an individualized surgical plan.

Creating a Comfortable Environment

The patient experience in the EMU is carefully curated to be as comfortable as possible. The unit is tailored for elective patients, acknowledging that these children are not sick but rather seeking evaluation. The EMU nursing staff, along with other professionals, strives to make the experience pleasant, offering engaging play activities and toys to create a welcoming atmosphere. Child Life specialists ensure the process is as comfortable as possible for patients.