eNeuro

When medication fails, epilepsy monitoring offers precise diagnosis

Diana Moses, R.N., A.C.N.S.-B.C., M.S., C.N.R.N.

Regional manager, neurosciences program development
Providence Brain Institute

Of the approximately 3 million Americans who have seizures or epilepsy¹, about one-third will have frequent seizures and won’t respond to medications.²

Patients taking medications have little chance of being seizure-free if they have failed two drug therapies at maximal efficacy. Those patients should be evaluated in an epilepsy monitoring unit, or EMU, to confirm that the seizures are epileptic and to localize seizure onset.

Providence Epilepsy Services provides epilepsy monitoring units at Providence Portland and Providence St. Vincent medical centers. Each unit has two dedicated rooms equipped with continuous EEG and video recording.

Fellowship-trained epileptologist Julia Toub, M.D., joins Providence Brain Institute

An EMU evaluation should be considered when your patient has frequent seizures despite trial of two anti-epileptic medications, or if you are concerned that your patient may have non-epileptic events. Non-epileptic events can result from psychological disorders (conversion disorder, depression or anxiety), cardiac conditions (syncope and arrhythmias), and other neurological conditions (migraine variants, TIAs, episodic memory loss).

Preparing patients for an EMU evaluation

Insurance authorization is usually required. Patients typically are admitted on a Monday and stay an average of three to five days, depending on how long it takes to capture several seizures or events.

Since patients cannot stay in the hospital indefinitely, their anti-seizure medication may be tapered and stopped, or they may be deprived of sleep to provoke a “typical” seizure. During a seizure, the nurse keeps the patient safe and performs an exam. Certain safety measures are in place to protect the patient: padded side rails on the bed, continuous pulse oximetry or cardiac telemetry, and frequent monitor checks.

This patient-preparation checklist gives more details.

To refer a patient for an EMU evaluation or to see an epilepsy specialist, contact neurologists
Julia Toub, M.D., at Providence St. Vincent Medical Center or Paula Gerber, M.D., at Providence Portland Medical Center. Pediatric neurologist Parvez Pohowalla, M.D., M.P.H., focuses on treating seizures in children.

References

1. Epilepsy Foundation (n.d.). Accessed from: http://www.epilepsyfoundation.org/about/statistics.cfm
2. N Engl J Med. 2000 Feb 3;342(5):314-9. Early identification of refractory epilepsy. Kwan P, Brodie MJ.