Patients with seizures, epilepsy, or episodes of an unknown cause may benefit from management in our Epilepsy Monitoring Unit (EMU) which is part of our Neuroscience Unit.

There are two common reasons for admission to the EMU:

• To determine whether an episode of concern is a seizure. This is referred to as differential diagnosis EEG monitoring.
• To record brain waves (and often seizures) in a patient with epilepsy to guide treatment. This can involve seizure classification, seizure burden assessment, or seizure localization as a component of an epilepsy surgery evaluation.

Patients in the EMU undergo continuous electroencephalographic (EEG) monitoring with time-locked video and audio recording. Patients receive care from our interdisciplinary team including neurologists, epileptologists, electroencephalographers, EEG Technologists, advanced practice providers and neuroscience nurses.

The duration of EMU admission depends on your child's condition, the goals of admission, and the recommendations of the healthcare team. Seizures and events are unpredictable, and sometimes we need to assess multiple events to make the best recommendations. Your child’s healthcare team, led by one of our neurologists, will discuss the progress and next steps with you each day.

Our EMU is accredited by the American Board of Registration of Electroencephalographic Technologists (ABRET) which ensures we meet exacting technical standards and can demonstrate high-quality recordings.

CHOP has a Level 4 certification from the National Association of Epilepsy Centers (NAEC). This is the highest-level certification, indicating we have a comprehensive approach and patient-oriented interdisciplinary team capable of performing the most complex forms of EEG monitoring, including surgical placement of intracranial electrodes as part of epilepsy surgery evaluations. NAEC has helpful information for parents about “How an Epilepsy Center Can Help.”

Preparing for EMU admission

• Welcome to EMU Overview
• One adult must stay with the child during admission to the EMU to help keep your child calm and entertained and to identify the events or seizures of interest. Please let us know prior to scheduling your child’s admission if you are unable to stay with your child during the entire hospitalization. We will try to arrange for a caregiver to remain in your child’s room during these times. This situation is not ideal, because we need your input to help ensure we understand and record the events you see at home.
• Staying in the EMU can be boring. We encourage you to bring your child's favorite toys, books and movies. We have a TV and a DVD player in every room. We have a Sony PlayStation 2 in most patient rooms. We have a large selection of toys, board games and crafts in our playroom that we can bring to your child. For older children, please bring schoolwork to keep up to date while away from school.
• Parents have 24 hour visiting privileges. Visiting hours for other visitors are from 9 a.m. to 9 p.m. Siblings are not permitted to stay overnight. We discourage you from bringing infant visitors.
• Every room has one parent sleep couch at the bedside. Although both parents can stay overnight, we can only provide one sleep couch. Most rooms also have a small desk. CHOP has internet throughout the institution so please feel free to bring your own activities or work.
• Please view "My Trip to the Hospital for a Video EEG" to help prepare your child for the study.
• An EEG is can be a stressful experience for a child. We have developed this resource to help you prepare the child in your care for what to expect and make the experience easier. We encourage you to read through this picture story a few times before the EEG. You can adapt the language to suit the child.
• Contact us with any questions at 215-590-9194.

EMU admission process

• On the night before admission, the Bed Management Team from our Admissions Office will contact you by phone and tell you when to arrive at the hospital.
• Your child’s hair and head must be clean. Please wash your child’s hair the night before the test. Please do not use hair spray, oils, cream rinse, or gel.
• The exact time of the admission cannot be determined in advance because it is dependent upon the times patients are discharged on your scheduled day.
• If you are going to be later than your scheduled time, then you must call the EMU directly (215-590-9194) so that we can try coordinate your arrival time with other patients. If you are late and haven’t called in advance, then we may need to reschedule your admission.
• When you arrive at the hospital, please report to the Admissions Office on the First Floor of the hospital within the main atrium. You will be registered and directed to your room. Your nurse will meet you and guide you through the next steps.

Initial steps and what to expect

• Most patients are admitted to private EMU rooms embedded in our Neuroscience Unit (NSU). We also have portable equipment which can obtain equivalent data in other locations when needed. The quality of the study is the same in all rooms.
• While in the EMU, your child will undergo EEG monitoring. EEG electrodes will be attached to your child’s head. Even tiny changes in electrode placement impact the EEG findings, so the EEG Technologist is aiming for perfect electrode placement. Attaching the electrodes is not uncomfortable, but children need to lay still in a flat position as the electrodes are attached to ensure they are placed in very specific locations. Sometimes we use a medical immobilizer to keep your child from moving. Our EEG Technologists, sometimes assisted by Child Life specialists, are experts in attaching electrodes in a child-friendly manner.
• We apply the electrodes with an adhesive called collodion. The collodion is dried with a small air compressor. The air compressor is noisy, but it is not painful. Once the electrodes are applied, gauze is wrapped around your child’s head to keep the electrodes in place. Our EEG Technologists have special training in applying the electrodes and head wrap to children. Some children may find the process scary at first, but there is no pain. Child Life specialists can help us make your child as comfortable as possible.

Ongoing care in the EMU

• While in the EMU, your room will undergo time-locked video and audio monitoring, allowing comparison of your child’s brain waves and behavior/movements. The cameras can record even overnight when the room is dark. We’ll make sure you know the camera locations to avoid blocking the video during an event or seizure.
• The wires linked to the electrodes are long so your child can move around the room. Patients do not need to remain in bed.
• We know an EMU stay can be boring. Nurses and Child Life specialists can help you with activities.
• We need one adult to stay with your child during the admission to help keep your child calm and entertained, and to identify the events or seizures of interest. When you need a break from your child's room, please let your nurse know to coordinate alternative coverage.
• We ask that when your child is awake you remain awake to help identify the events or seizures. You don't need to stay awake when your child is asleep.
• The EEG tracing is reviewed several times per day by our EEG Technologists and electroencephalographers. Our EEG Technologists are in the hospital 24/7, and they are board-certified by ABRET.
• Members of the Neuroscience Center will discuss the plan with you upon admission. The Center’s team, led by a neurology attending, will also discuss the EEG data with you each day during rounds which usually occur between about 8-11 a.m. Each day you’ll decide on the next steps for monitoring and management.
• The EMU is staffed by an interdisciplinary team consisting of many specialties. Depending on the needs of your child, the team may include neurologists, epileptologists (neurologists specializing in epilepsy), electroencephalographers (neurologists specializing in EEG interpretation), EEG Technologists, neuroscience specialized advanced practice providers, neurology and epilepsy residents and fellows, pediatrics residents, neuroscience specialty nurses, Child Life specialists, psychologists, psychiatrists, social workers, case managers, and pharmacists.
• CHOP is a teaching hospital so you may meet medical students, nursing students, and EEG trainees who are under the supervision of experienced staff.

Your role during events or seizures in the EMU

If your child has a seizure or suspicious event, you must:

• Try not to block the camera. Seeing the child during the event helps us best understand it. Try to remove blankets or push furniture out of the way so we can see your child's body.
• Audio is being recorded during the monitoring. During an event, loudly describe what you are seeing. For example, "My child is staring" or "I see shaking of the left arm." This helps us understand movements or behaviors we may not be able to see on the video.
• Push the event button. The EEG Technologist will show you this button in your room. Pushing this button marks the event on the EEG recording and allows us to find the event easily. If you don't push the button, then it is sometimes hard or impossible to find the exact event of interest.
• Write down the time of the event and a detailed description of the event on the paper the EEG Technologist gives you upon admission. It helps to write down details while they are fresh in your mind.

Children with behavioral problems

Please download and fill out the following forms if your child has any behavioral problems that you would like to bring to the medical team’s attention. Our interdisciplinary team has considerable experience performing EEG monitoring even in children with substantial behavioral problems.

• Behavioral questionnaire
• Tips for your child's care

Caring for your child's skin after electrode removal

• You may notice marks on your child’s head once the electrodes are removed, especially if the electrodes were attached for a long time. Fair or thin-skinned heads are more likely to have small, temporary indentations. You may notice redness, puffiness, and slight blisters/scabs.
• Do not rub the irritated area. Rather, gently blot dry when needed. We suggest using Neosporin® if there are marks. The marks can take up to two weeks to vanish.
• Call your neurologist or pediatrician if you have concerns.