What is The Long-Term Monitoring Unit and why is my doctor sending me to the unit?

The Long-Term Monitoring Unit is a specialized section of a hospital or clinic for diagnosing persons with seizures or poorly understood episodes of altered consciousness. The Unit is staffed by an attending neurologist who has had specific training in the diagnosis and management of epilepsy and seizures, registered nurses, and EEG technologists.

Patients are admitted to the Unit when their condition requires prolonged EEG monitoring. This is done to: characterize the seizure type; localize the area where the seizure begins; to rule out other conditions that can be confused with seizures. The information can help the physician design a specific treatment plan for each patient.

Epilepsy monitoring usually requires patients to stop taking some or all of their antiepilepsy medications (AED). This may result in more frequent and more intense seizures. Patients may be asked to stay awake all night to provoke seizures.

Patients in the Unit receive continuous EEG and video monitoring. The EEG monitors electrical impulses from the nerve cells in the brain to record the brain’s activities. EEG wires are glued to the scalp and connected to a computer which stores the information. The EEG is recorded continuously 24 hours a day. In addition the patient is monitored by video to characterize the way a seizure looks as well as to allow the nursing staff to tell when a patient requires assistance. Monitoring typically requires a three- to five-day continuous stay.

Information from the study is used to develop the most appropriate treatment plan for each patient. A monitoring study can help determine:

  • The type of seizures that are occurring
  • Where seizures are occurring in the brain (localization)
  • If all episodes are seizures or normal movements
  • If the patient is a candidate for alternative therapies or treatment

What are the risks of this test?

There are some risks and they include all of the usual risks associated with having a seizure. The risks include injury to muscle, bones, or nerves, head injury, even death. The testing is therefore done in a controlled setting with continuous monitoring by video and with a nurse close by. The attending neurologist is on call 24 hours per day for the Unit. The monitoring is considered worth the risks listed above because uncontrolled seizures also have the same risks and it is important determine the best treatment plan for an individual patient.

Why can’t we just use information from an outpatient EEG?

A 20 to 40 minute EEG is able to capture the abnormal brain waves about 50% of the time. The long term monitoring unit testing can do so 95% of the time. An outpatient EEG gives us a “snapshot” of the brain’s activity. This may not be sufficient to acquire adequate information. Long-Term monitoring gives us a “movie” that supplies more and better information on brain activity.

Will my anti-antileptic drugs be changed or stopped while in the EMU?

Most of the time, AEDs will be reduced or even stopped. To make it more likely that seizure will occur. Some patients require invasive electrode monitoring (phase II) where small electrodes are inserted into brain tissue, or electrodes are placed directly on the brain surface. These procedures are performed if it is unclear where seizures begin in the brain.

What to Expect

A patient who is going to have video-EEG monitoring should bring clothing that can be buttoned, as sweaters and shirts to be pulled over the head can interfere with the EEG wires. The patient should also bring reading materials and other things (knitting, sewing, paperwork) to keep busy, as a prolonged stay for monitoring can be boring. At the Long-Term Monitoring Unit we have an extensive library of books and DVDs for patients to enjoy. Personal electronic devices are allowed. Finally, patients should expect to be fairly immobile (either in the bed or a chair), as they should be on camera at all possible times and will only have a limited extension of cord that allows them to use the restroom in private.