MGH Epilepsy Monitoring Unit
The Epilepsy Monitoring Unit is a specialized inpatient unit located in the Neurosciences Care Unit on the 8th floor of the new Lunder Building at 55 Fruit Street. Patients are admitted to the Epilepsy Monitoring Unit for detailed diagnostic evaluation of their seizures and spells. In the Epilepsy Monitoring Unit our goal is to observe and record seizures using continuous EEG and video monitoring. These recordings allow us to make specific diagnoses of spells, and to precisely localize the source of epileptic discharge from the brain. Ultimately this type of detailed diagnostic information is used to develop a specific treatment plan designed for the individual patient that may include medications, surgery, or a device-based therapy.
You will be admitted to the Neurology Service, which includes the Epilepsy Monitoring Unit. Your “Attending Physician” will be the doctor who is assigned to the Neurology Service for that month. The Epilepsy Fellow and Neurology Residents (doctors who are furthering their specialization in Neurology) will coordinate your care.
The members of your Epilepsy Service team may include an epileptologist; a neurosurgeon; epilepsy fellows, a nurse coordinator and members of the administrative staff. The team also includes the members of the EEG Laboratory, neuropsychologists, neuropsychiatrists, neuroradiologists and the nurses on the Neurological Specialty unit in the hospital
When you have completed your monitoring visit we will send a detailed summary report including our opinions and recommendations, to your referring physician and/or MGH Epilepsy Service physician.
This guide to the pathway through the Monitoring Unit will assist you in understanding what to expect each day during your hospitalization. Day to day schedules and types of care may change according to the patient’s needs.
You are encouraged to ask the staff if you have any questions about your care. Care pathway “managers” will follow you through your hospital stay. These managers are advanced practice nurses with expertise in neuroscience and are available to answer your questions.
Your Pre-admission Appointment
The purpose of this visit is to review your medical history, determine a treatment plan, and help you understand the hospitalization process, your role, and your expected discharge plans.
A regular EEG or sleep deprived EEG may be ordered at this visit if one has not already been done. In addition, an MRI or PET scan may also be ordered, even if you have already had one.
Take your usual medications at your regular time unless instructed otherwise. Your doctor may ask you to decrease some of your medications on the day prior to your admission. Continue usual activities at home.
Keep your regular diet leading up to the admission.
Length of Stay
Your total hospital stay may be as short as 2 days or as long as 7-10 days depending on the frequency of your seizures.
You might want to start collecting reading material, puzzles, games and hobbies to help pass the time during your hospital admission. You are welcome to bring a laptop computer with you. Television service is available for an additional five dollars per day. You may have visitors during regular hospital visiting hours. Smoking is not permitted.
If you have any questions regarding your admission or other matters you can meet with the epilepsy nurse. Before your admission date you will receive an Admission Letter. Please follow the instructions in the letter.
Starting on this day, we will record your habitual seizures while performing continuous video and EEG monitoring to identify the brain area from which the seizures originate.
Tests and Monitoring
Please arrive at the admitting department at the time stated in your Admission Letter. You’ll be sent to the EEG Lab on Bigelow 12 to have electrodes placed. Depending on your seizure type, you may have very thin wires placed into your cheek muscles using a local anesthetic.
An I.V. “heplock” will be placed in your arm during your hospital stay. After admission, your doctor will reduce your usual seizure medications gradually over a few days.
You will not be able to wash your hair or shower until the EEG study is finished. Since you will be unable to pull clothes over your head, please bring clothes that fasten up at the front. You may walk around the room and sit out of bed, however you must call the nursing staff when using the bathroom.
You can have a regular diet. Note: please do not chew gum because it interferes with the EEG recording.
Nursing staff will help you find your way around the floor.
Your Stay – Day Two Through the Day Before Discharge
During your stay, we will try to optimize the occurrence of seizures so we can understand the type and frequency of your seizures. During this time you will be closely attended your nurses and other team members who will work together to help make you as comfortable as possible.
Tests and Monitoring
Video and EEG data will be collected until the day of your discharge from the hospital.
If you need a PET Scan, it will be done either on a Tuesday night or a Thursday. You must not eat from midnight the night prior to this test. Your Neurology team will inform you when the PET Scan has been scheduled. Your blood will be drawn every other day.
On the night before being discharged from the hospital, an MRI may be ordered for the day of discharge.
Your medications will continue to be tapered off and possibly discontinued during your hospital stay.
On the day prior to discharge your medications will be restarted.
You will be deprived of sleep every other night during your hospital admission to help enhance the frequency of your seizures. The nursing staff will help you stay awake. Videos are available from the EMU library free of charge.
As a rule, each day you will be informed on the progress of the recording session. The Case Manager or social worker may meet with you and your family to talk about any concerns you may have.
We make every effort to give you twenty-four hours notice to arrange transportation to your home, however we regret that this is not always possible.
Going Home – What to Expect on the Day of Discharge
You will receive written discharge instructions. Instructions will include information we have gathered since your first pre-admission appointment.
A follow-up appointment with your epilepsy doctor will most likely have been made before you were admitted to the Epilepsy Monitoring Unit. If not, an appointment will be made at this time.
Tests and Monitoring
The EEG electrodes will be removed on the day of discharge. If an MRI was ordered the night before, the EEG electrodes will be removed prior to the MRI.
We will have restored your medication to therapeutic levels to ensure your safety prior to discharge from the hospital. Continue taking medications as instructed.
Return to your usual routine at home.
Return to your regular diet.
Doctors and Schedules