Washington-Five professionals who care for people with epilepsy shared their thoughts on how to improve the experience of patients who are admitted to the epilepsy monitoring unit. Judy Ahn-Ewing, a registered EEG technician, explained that patients usually come to the hospital for EEG/video monitoring for one of two reasons; to record their seizures in order to make a diagnosis, or to record seizures in preparation for epilepsy surgery. However, patients may feel isolated from their families and jobs while waiting to have seizures in the hospital. It also may seem confusing to patients that they are ‘trying to have a seizure’, rather than trying not to have one. Ms Ahn-Ewing suggested that nurses should spend more time educating patients and their families as well as providing recreational activities to make the stay in the epilepsy monitoring unit more pleasant. Patient safety, such as providing padded bedrails, is also very important.

Dennis Dlugos, MD, Head of Clinical Neurophysiology, Children’s Hospital of Philadelphia, PA, observed that interpreting EEGs of children can be more difficult, because they move around a lot. Children also require more supervision than adults when they have depth electrodes, which go inside the brain, so they do not get hurt. In the intensive care unit, seizures need to be treated as soon as possible, and staff needs to be available 24 hours/day. Many children with seizures can avoid a hospital admission to the epilepsy monitoring unit by having 3-4 hour outpatient EEG/video in the doctor’s office, “One needs to balance clinical needs with what a child and family will tolerate,” said Dr. Dlugos.

Collin Hovinga, PharmD, a neuropharmacologist from Miami Children’s Hospital Research Institute, Miami, Florida, explained that antiepileptic drugs must often be discontinued while the patient is in the epilepsy monitoring unit in order to record the patient’s typical seizures. If the medications are withdrawn too fast, the patient may have more severe seizures than usual, but if they are withdrawn too slowly, the patient may have to stay in the hospital for days waiting for a seizure. Getting it just right is a matter of experience and judgment. Dr. Hovinga suggested that patients with mild seizures can begin decreasing their antiepileptic medication prior to admission to the epilepsy monitoring unit, so that when they come in their antiepileptic drug levels are already low. As a general rule, doses should be reduced by about 1/3 or 1/4 per day. This should be done as an outpatient only if the patient has adequate supervision by a family member or other responsible person. Sometimes antiepileptic drug withdrawal causes psychiatric problems, such as aggressive behavior, anxiety, depression or psychosis. Family members and medical staff need to be on the watch for any change in a patient’s behavior so that appropriate treatment can be given.

“Having someone admitted to the hospital for 3-5 days is a huge impact on the family,” observed Lynn Bennett Blackburn, PhD, a pediatric neuropsychologist at Children’s Hospital, St. Louis, MO. Children will miss school, and adults may miss work. If one parent is hospitalized, the other one has to pick up the slack at home, which may cause additional stress. In addition, being ‘on camera’ 24 hours a day doesn’t allow for much privacy (although patients are not videotaped in the bathroom). Dr. Blackburn recommended that nurses address patient fears and expectations and that staff receive more training materials. She suggested that an instructional video might help prepare patients for an admission to the epilepsy monitoring unit.

Mary Bare, MSPH, RN, an epilepsy education consultant, emphasized common sense rules for safety in the epilepsy monitoring unit. Beds, cribs, and floors should be padded, and patients should not hold sharp objects such as pins or knitting needles. All electrical equipment has to be well maintained and operated safely, and everything should be cleaned properly to prevent infection. Supervision 24 hours a day will help preserve patient safety.