24/7 Epilepsy Monitoring Advances Care

By Amber Mitchell, MD  |  5/25/2017

To help diagnosis and treat epilepsy and seizures, Northern Dutchess Hospital opened an epilepsy monitoring unit in April. Under the supervisor of a neurologist, the patient is monitored continuously overnight on camera and via an electroencephalogram (EEG), a test that evaluates the electrical activity in the brain.

The goal is for the patient to have an "episode" and use the data captured by the EEG and video footage to determine if the spell is a seizure or something that mimics a seizure, such as a common fainting spell, a movement disorder or a stress response.

Three general groups of patients are monitored. The first includes undiagnosed patients. They have seizure-like spells, but they have not been witnessed by the physician or captured on a routine outpatient EEG.

The EMU stay is undertaken to properly diagnose the patient. Otherwise, physicians are treating based on the patient's description of symptoms alone.

The second group of patients has already been diagnosed with epilepsy, but has struggled with medication side effects. They would stay in the unit so a physician can safely start a new anti-epileptic medication without the perils of doing so without continuous supervision. During medication adjustments, seizures may surface. Therefore, an EMU at a hospital is preferred.

Patients with a known seizure disorder may also develop new "episodes" that need to be characterized. The goal is to determine if the new spell is epileptic or non-epileptic in nature, thus providing a reassurance and avoidance of further medication increases.

The final category consists of patients with epilepsy that doesn't respond to multiple medications. They continue to have multiple seizures a month and have undesirable side effects from the combinations of the medications. Often, they cannot drive, have trouble dating and holding a job, and have a poor quality of life.

After I identify a patient with focal or localized epilepsy, I will refer them to a specialized epilepsy surgery center. Surgery often involves removing the small part of the brain that causes the seizure to begin, and may result in reduction in medications, or cure the symptoms.

Regardless of the type of patient monitored, the EMU session provides valuable information that can really change lives by getting patients on the right medications, eliminating unnecessary medications, or setting them on the path to life-changing epilepsy surgery, which can be curative.

Dr. Amber N. Mitchell is a neurologist who specializes in seizures with Health Quest Medical Practice's Division of Neurology in Kingston. She helped open Northern Dutchess Hospital's epilepsy monitoring unit in April. For an appointment, reach her office at 845-331-5165 (TTY: 800-421-1220).