The clinical Epilepsy Center has an inpatient epilepsy unit dedicated entirely to diagnosis and treatment of problem seizures.
Phase 1 Monitoring
The clinical Epilepsy Center has an inpatient epilepsy unit dedicated entirely to diagnosis and treatment of problem seizures. This five-bed unit can perform computer-enhanced video-EEG monitoring in order to capture episodes that might be seizures or one of the many imitators of seizures. The unit can admit children, or use two portable recording stations in Lucile Packard Children’s Hospital. Such monitoring can both diagnose epilepsy and determine whether it is in a surgically accessible area of the brain and amenable to cure.
The center works closely with the most advanced techniques of neuroimaging, including high-resolution MRI, fast CT scan, CT scan, SPECT, MR spectroscopy and functional MRI. We have available brain mapping procedures that image seizure foci in relation to critical regions of brain function. We can perform invasive monitoring with wires or grid electrodes in and on brain to better localize the seizure focus. We also perform research in new antiepileptic medications.
Inpatient video-EEG monitoring in our Epilepsy Monitoring Unit (EMU), located on the F3 Neurology Ward or Packard Children’s Hospital for young children, is used in selected instances for one of four purposes:
1. To diagnose whether a condition is epilepsy or one of its imitators.
2. To determine what type of epileptic seizures patients are having, to guide therapy.
3. To determine whether patients are having more seizures than recognized, in order to explain confusion or other troublesome symptoms.
4. To localize where seizures come from in the brain (the seizure “focus”) as a possible prelude to operating on the focus to treat medically-intractable seizures.
Inpatient video-EEG monitoring is basically a long EEG, together with video and sound recording, extra EEG channels and computer enhancement of certain EEG patterns. Patients can be in the hospital for monitoring from one to 14 days, typically 3 - 7 days, depending upon frequency of events. Seizure medications may be tapered in the hospital to provoke seizures for analysis, under highly controlled conditions. Do not stop your seizure medicine before coming in for monitoring, unless your doctor specifically advises you to do so.
While in the monitoring unit at Stanford, you can reside in a hospital bed or sit in a chair. Walking around the room is permitted with assistance and precautions against falling from a seizure. The EEG cable reaches into the bathroom, where you have off-camera privacy. A relative can stay with you in the room if desired, sleeping on a cot, but such companionship is not required. Wear clothing that buttons, and can be removed without pulling over the head. Bring things to read and do, while waiting for a seizure.
During monitoring, we perform a variety of evaluations of your medical condition, and also of stress factors and mood changes that commonly accompany severe seizures. If episodes do not occur spontaneously, we may try to provoke them with medication reduction, sleep deprivation, exercise, flashing lights, hyperventilation (over-breathing), hypnosis, or any maneuvers that you tell us tends to bring on your seizures.
About 1 in 5 people undergo video-EEG monitoring with no episodes. However, some of these individuals have EEG abnormalities picked up by the recording devices, which helps to diagnose their episodes. A few people have non-diagnostic admissions.
Phase 2 Monitoring
If you are considered to be a possible candidate for epilepsy surgery to treat your seizures (see below for explanation of epilepsy surgery), but more detail is needed to localize where your seizures are coming from in brain, then you may be admitted to Stanford for Phase 2 monitoring.
The Phase 2 monitoring employs electrodes in the form of wires or flexible sheets (called strips and grids) that are placed directly on or in brain tissue to map the seizure origin. This is done by neurosurgeons in the operating room. Grid electrodes can be used both for recording and for stimulating brain tissue to identify the underlying function, e.g., language areas, sensation or motor function. The map of where seizures arise in relation to critical brain sites can be very helpful to the surgeon. Invasive electrodes remain in place for a few days to up to 1-2 weeks, as needed to record seizures and map brain. They are then removed and epilepsy surgery performed, if finding are favorable for such surgery.