Our Services

Epilepsy Monitoring Unit

Children's Hospital of Pittsburgh of UPMC’s Epilepsy Monitoring Unit (EMU) is one of the most technologically advanced in the nation. Each of the eight private rooms in the EMU is fully equipped with state-of-the-art EEG equipment, video monitors and intercoms to ensure instant communication with the EMU techs and nurses. The Command Center is staffed 24 hours a day, seven days a week by EEG techs. Our patients receive individualized, customized treatment and personal care by our techs and nursing staff.

What is the Epilepsy Monitoring Unit?

The Epilepsy Monitoring Unit (EMU) is a specialized 8-bed unit within Children's Hospital of Pittsburgh of UPMC where children’s seizures are evaluated, monitored and recorded using digital EEG monitoring and neuroimaging studies.

Patients may stay in the EMU for several days while receiving continuous video EEG monitoring, which records the electrical impulses from the brain that can cause seizures. This activity is monitored continuously by the EMU Command Center. The EMU is staffed by nurses, technicians, and epileptologists who are experts in epilepsy, and dedicated to the personal care and comfort of each child.

Who Gets Admitted to the EMU?

Patients admitted to the Epilepsy Monitoring Unit (EMU) include children and teens with events that may not yet be diagnosed as epilepsy, or who have had a change in their seizure patterns. Patients with intractable epilepsy (Phase I) are those whose epilepsy does not improve with medications.

Diagnostic Video EEG (VEEG)

A patient admitted for a diagnostic video EEG (VEEG) may have a seizure disorder that has not yet been diagnosed as epilepsy, or their epilepsy has worsened. They will be monitored in the EMU so that their events can be captured on the EEG and a diagnosis can be made or confirmed.

Patients typically have a consultation with a Children’s Hospital neurologist to determine if admission to the EMU will be helpful in diagnosing the child’s condition.

Phase I

A patient is referred for a Phase I if they have been diagnosed with epilepsy and have not had success with other epilepsy treatments. Each patient is given an individualized treatment plan that may include any or all of the following tests:

video EEG
SPECT
PET
MRI
language evaluation
neuropsychology test
psychiatric evaluation

During your child’s stay in the EMU, he or she may need to taper their anti-seizure medicines or stop taking them to allow for seizures to occur. Other triggers, such as sleep interruption or exercise may be used to bring on a seizure.

After the Phase I evaluation is complete, the EEG, SPECT, and other studies are reviewed by multiple physicians, residents and fellows, who all provide their expertise in diagnosing the child’s condition and make recommendations on treatment.

Phase I Outcomes

A child can have one of three outcomes after completing their Phase I evaluation in the EMU:

The child is taken directly to surgery where a portion of the brain will be resected.
No surgical option is possible, either because the abnormal activity cannot be confined to one area of the brain, or because the abnormal part of the brain is too close to the area responsible for motor or language function.
A Phase I patient may be advanced to Phase II, where more information is needed before surgery can be scheduled.

Phase II

A craniotomy is performed and subdural grids, which are electrodes embedded in a strip of flexible material, are placed directly on the surface of the brain. The child will spend the first night in the Intensive Care Unit (ICU) until his or her condition is stabilized. The cables from the grids are attached to a portable EEG, and their brain activity is monitored. This tells the physician where the seizure activity is coming from. Once stable, they will be taken to the EMU for 5 to 14 days. The child will have continuous Video EEG (VEEG) monitoring during the length of their stay in the EMU.

Learn more about how subdural grids help surgeons identify which area of the brain to resect.

The EMU Experience

Prep for the EMU

Two to three days prior to the child’s EMU appointment, a scheduler will call the parent to confirm the appointment and to collect some important information about the child’s condition and any special needs they may have. She will go over the instructions with the parent, including what to bring (toys, change of clothing, favorite blanket, medications, etc.), where to park, and location of the admissions office.

Arrival

When you and your child arrive at the EMU, you will be welcomed by the nursing staff, your child will be weighed and measured, and you will be oriented to your private room. The child’s nurse will perform a brief nursing assessment and answer any questions you may have.

Video EEG Monitoring

The EEG tech will explain the EEG process and your child will be taken to the application room where the EEG electrodes will be applied to the scalp. More than 24 electrodes are applied to the scalp with special glue. Squares of gauze are dipped in the glue, placed over the electrodes, and an air compressor is used to dry the glue. Your child’s head does not need to be shaved for this procedure.

Once the electrodes are in place, your child will be taken back to his or her private room where the tech will connect the electrodes to the EEG equipment. The child will have limited mobility and is not able to leave the private room during his or her stay in the EMU. The electrode wires are joined to a small box that the child can carry with him or her when going to the private bathroom or when moving from the bed to the chair.

From the Command Center in the EMU, techs control the video monitor of each child, zooming in and out and moving the camera as the child moves so that the child is recorded at all times. They can also use an intercom to communicate to the doctors, nurses and/or parents in the room about the child’s condition when a seizure occurs.

Baseline EEG

After the electrodes are applied and the child is settled in his or her private room, the EEG tech will spend the next 40 minutes recording a baseline for the Video EEG (VEEG). The child will be asked to relax, keep his or her eyes closed, blow on a pinwheel or breathe deeply. A flashing strobe light will be used for about three minutes. The tech will ask questions to test for responsiveness. This interaction gives our specialists information about the child’s ability to communicate, and prepares the child for the same questions that may be asked during or after a seizure.

Then your child will resume normal activities, such as reading, doing homework, playing video games, or watching TV. Portable electronics such as laptops are allowed as long as they don’t interfere with the EEG equipment.

The Parent’s Role

One parent is required to be with the child at all times during their stay in the EMU. Each room contains a private bathroom and a couch for the parent to sleep on. The parent can be instrumental in alerting the EMU staff when their child begins to have an event. When the parent pushes the alert button, it signals to the EEG techs, marks the EEG itself, and alerts the nurses to provide safety interventions.

Discharge from the EMU

Once your child’s stay in the EMU is over, the EEG tech will disconnect the patient from the equipment. The electrodes are removed with a special solvent and the child’s hair is washed. The nurse will provide discharge education to the parents and the parents will sign discharge papers.

Result will typically be sent to the referring physician within 2–3 weeks.

Learn more about our digital monitoring and neuroimaging studies.

Last Update
July 2, 2012

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