The Epilepsy Monitoring Unit
The Epilepsy Monitoring Unit (EMU) at Duke University Hospital is located on the 4th (for adults) and 5th (for pediatrics) floors of Duke North building. It consists of hospital rooms equipped with specialized equipment that allows for continuous recording of EEG, video and audio. Dedicated and specially trained staff including nurses, EEG technologists, monitoring technicians, epilepsy nurses, and epileptologists are also a critical portion of the EMU.
There are several possible reasons or indications for why a patient might be admitted to the EMU. For most, this is a decision made by their outpatient neurologist or epileptologist.
For some patients, there is uncertainty about their diagnosis after having seizure(s). For example, someone may be admitted to determine:
- Whether the episodes they are having are epileptic seizure or not
- What type of seizures they might be having
- How frequently the seizures may be happening
As part of this admission, patients will often have seizure medications adjusted or tapered in order to record the events. The equipment, personnel and protocols in place in the EMU are especially designed to obtain the needed data in the safest possible environment. In most cases, it is necessary for a friend or family member to be present for the duration of the admission to act as an observer.
After admission, the EMU team will take a detailed history, including any changes or updates since the last visit in the clinic. The EEG electrodes are then applied by a neurodiagnostic (EEG) technologist and video and EEG recording are started. The patient and their observer will be instructed on how to let the team know if they are about to have or have had a seizure. Any changes to medications or other tests will be discussed with the patient. The EMU team will round on the patient on a daily basis to discuss the results to that point as well as plans for the day/admission.
Presurgical Evaluation Admission
For some patients with epilepsy, seizures may not be adequately controlled with medications. If a patient has tried several medications without adequate control, they are considered to be intractable to medications. In such cases, an evaluation may be undertaken to determine if someone is a candidate for surgery as a means of improving their seizures. One of the key parts of this evaluation is an inpatient video EEG performed in the EMU.
The procedure is the same as for a Diagnostic Admission, with some small changes. To learn more about the Epilepsy Surgical Pathway and the Complex Epilepsy Program please refer to the Complex Epilepsy Program page.
Neuropsychological (Neurocognitive) Testing: Neuropsychological testing used to get a detailed pictures of a patients cognitive (including memory, attention and language) functions. It consists of a set of written and oral questions and tasks administer by a neuropsychologist and their assistants. Results are compared to the typical performance of people who are the same age and have the same amount of formal education as the patient. The results help to identify both areas of relative strengths and weaknesses. The pattern may suggest particular parts of the brain that are functioning as expected and those that are not. In many patients, parts of the brain that are not functioning well may correspond to areas involved in seizures.
Intracarotid Sodium Amytal Test (Wada Test): The Wada test is used to determine if patients are a good candidate for epilepsy surgery. To learn more about epilepsy surgery at the Duke Comprehensive Epilepsy Center please refer to the Complex Epilepsy Program page.