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.

Your Team

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.

What to Expect – Your Guide to The Epilepsy Monitoring Unit

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.

Tests
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.

Medications
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.

Diet
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.

Activities
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.

Other Information
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.

Admission Day

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.

Medications
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.

Activity
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.

Diet
You can have a regular diet. Note: please do not chew gum because it interferes with the EEG recording.

Other Information
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.

Medications
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.

Activity
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.

Other Information
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.

Medications
We will have restored your medication to therapeutic levels to ensure your safety prior to discharge from the hospital. Continue taking medications as instructed.

Activity
Return to your usual routine at home.

Diet
Return to your regular diet.

Frequently Asked Questions

Medications

It is important that you bring all your medications with you to the hospital. We will review them with you, but also, on rare occasions they may not be available from our formulary. Your own supply could be the only way to get the medication.

If necessary, be sure to request medication refills before discharge.

Diet

With the exception of gum or caffeine products you may stick to your regular diet. Gum is prohibited since the chewing motion of the jaw interferes with the EEG recording. Caffeine is a stimulant and may interfere with your sleep/wake cycle while in the hospital. We would like to be able to control this cycle while you are with us.

Activities

Massachusetts General Hospital has a No Smoking Policy for the entire hospital. If you are a smoker and would like to request a nicotine patch or other smoking cessation aids during your admission, please let the physician know upon your admission.

This is permitted provided your equipment meets the safety requirements of the Massachusetts General Hospital. A TV is available in your room at a cost of $5 per day. A VCR will also be available for your use and videos are available from the hospital library at no charge.

You will be unable to leave your room while you are hooked up to the monitoring equipment that includes EEG leads. The cable is about 20 feet long, and allows relatively free movement within your room.

You will be unable to wash your hair or shower while you are hooked up to the EEG equipment. There is no electrical hazard, but such activities would disturb the recording contacts.

Please be sure to ring for a nurse before using the bathroom as they will need to assist you with the equipment.

Doctors and Schedules

Your admitting physician, (the doctor who is assigned to the Neurology Service for that month) will be in constant contact with the Epilepsy Fellow and the rest of your team and will stop by to see you if time permits. The Epilepsy Fellow in charge of your care during your stay will see you and review your EEG daily.

If your epilepsy physician was unable to discuss the monitoring findings with you before your discharge, check to be sure that you have a follow up appointment in the Epilepsy Clinic in about six to eight weeks after your discharge.

Please know that we do everything possible to assure you of your exact admission date.  Occasionally patients are in the hospital longer than anticipated, which may make it necessary to delay the next patient’s admission. This is rare, but does happen from time to time. Should you be delayed, you will be brought in on the very first day available after your scheduled admission date. We hope that this unusual situation won’t happen, but ask for your patience and understanding if it ever does.

Company

Typically, we are unable to accommodate this request due to patient census, availability of hospital beds and other regulations. The final determination however is at the discretion of the charge nurse on Ellison 12 where you will be monitored and must be approved by the charge nurse.