Safety in an Epilepsy Monitoring Unit

An epilepsy monitoring unit (EMU) is a hospital unit run by a health care team who specializes in caring for people with seizures and epilepsy. People may be seen in outpatient settings and on an inpatient unit for specialized testing, medication changes, or surgery.

Before changes in treatment are recommended, people are usually admitted for specialized EEG testing called video EEG monitoring (VEEG). This test may also be called continuous EEG monitoring or long-term monitoring (LTM). The goal of the testing is to record a person during a seizure and compare the electrical activity of the brain to what the event looked like or what the person felt.

Results of this monitoring can tell if an event or change in behavior was an electrical seizure that would be associated with epilepsy. Sometimes other causes for events can be found. If the seizure was epilepsy, then the type of seizure and where it may have started in the brain is important information to learn.

The EEG testing can determine if a new seizure medicine may help and if so, which one. The testing may also help determine if surgery or placement of a device such as a vagus nerve stimulator or responsive neurostimulator may be options to consider.

Are there any safety concerns with EEG monitoring?

Yes, there are. When a person comes into the hospital for EEG monitoring, one or more of the following may occur:

• Seizures may be provoked or triggered by lowering or stopping a seizure medicine.
• A seizure medicine may be stopped if it wasn’t working well enough or caused too many side effects.
• A new seizure medicine may be started and the full dose may not be reached by the time you go home.
• Injury can occur during a seizure. (The hospital staff will have safety precautions to help prevent this, but seizures and injuries can be unpredictable.)
• Seizures may be different than usual; they may last longer, or they may happen more often and closer together.
• Changes in seizures and medicines could need emergency treatment. (That is why people are in the hospital when this is done, so care is available if someone needs it.)

What can people do to prepare for admission to an EMU and stay safe?

• Meet with your epilepsy doctor and nurse before admission to learn what is planned and how you can prepare. The more your epilepsy team knows about you ahead of time, the better they can help you! 
• Make sure your epilepsy team knows if you have had seizure emergencies or injuries in the past.
• Tell your epilepsy team if you have had changes in mood, sleep or behavior (the way you act) when a seizure medicine has been changed or after seizures.
• Ask what medicine changes are planned and why.
• Ask if they will lower medicines to record seizures and if yes, how. What medicine will be changed? If this has been done before, tell your team what happened and if it helped.
• Ask about plans to stop seizures. The term “rescue” medicine or “prn” medicine may be used. Usually a medicine is given into a vein. If this doesn’t work for you, tell them. A different way of giving seizure medicine quickly will need to be used.
• Learn what safety precautions will be used, what you can do in the hospital and what you can’t do. You likely will not be able to walk around on your own when you are at risk for falls or more seizures.
• Bring activities to keep you busy. It can be boring in the hospital!
• Tell the staff how you are feeling. Being in the hospital, having more seizures and changing medicines can be very hard physically and emotionally. The epilepsy team may not realize right away how you are feeling if you keep it to yourself.
• Please know that you are the key player on your team. You need to tell others how you feel and make sure your team talks to you about what is going on.
• Have a family member or friend with you before you are discharged so they can help you prepare to go home. Memory is not always as clear as you would like it to be.
• Don’t plan on going right back to your usual activities. Plan on staying with someone for a few days or until your epilepsy team thinks you are safe to be alone (if you lived alone before admission). Also ask when you should plan on resuming your usual activities.
• Make sure you have follow-up appointments made. You’ll need to see your epilepsy team to make sure your medicines are stable and that you are tolerating changes that were made. You’ll also want to learn about results of your testing and what the next steps may be.

Being admitted to an epilepsy monitoring unit can be unsettling or scary, but it also can be very helpful! A correct diagnosis will lead to better treatment and a chance to get seizures controlled.

Next week, we’ll talk about other safety concerns and questions to ask your epilepsy team.
Best wishes for a safe week!

Patty Osborne Shafer RN, MN
Associate Editor/ Community Manager