Evaluation for individualised epilepsy treatment

Epilepsy, seizures, and seizure-like disorders can be challenging to treat. Every person with seizures is different, and the best treatment may include medication, stimulation techniques, diets, or surgical procedures.

Identifying the most appropriate treatment plan for you or your family member starts with a thorough evaluation and diagnosis. Equipped with computer-based monitoring equipment expressly designed for the evaluation of seizure disorders, the EMU team can gather data before a seizure starts, while one is occurring and during recovery.

This approach can provide answers about your child’s seizures’ characteristics and help doctors identify the type(s) of seizures and other clues that can shape your treatment.

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

There are two common reasons for admission to the EMU:

  • To record an episode 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 known epilepsy to guide treatment. This can involve seizure classification, seizure burden assessment, or seizure localisation.

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, EEG technologists and 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.

What to expect when you visit our EMUs

Prof. Sunny Philip, Consultant Paediatric Neurologist and epileptologist, Director of the paediatric EMU at Mediclinic Hospital, shares details about the unit and its purpose, why patients are referred, and what happens after discharge.

Preparing for your EMU admission

  • We request that one adult stay with your child during admission to the EMU to help keep your child calm and entertained and to identify the events or seizures of interest.
  • Staying in the EMU can be boring. We encourage you to bring your child's favourite toys, books and things which makes your child to not get bored. For older children, please bring schoolwork to keep up-to-date while away from school.

Pre EMU admission process

  • 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.
  • If you are going to be later than your scheduled time, then you must call and inform us, 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.
  • Please arrive 30 minutes before your scheduled time so that you can complete the admissions paperwork and arrive to the unit on time.
  • On arrival to the hospital please go directly to the admissions desk, you can ask the concierge of you are unsure of the location. It is located to the right once you enter the main entrance of the main building.
  • Admissions will have all your prepared paperwork such as approvals. They might ask you for your Emirates ID or Insurance card so remember to bring this with you on the day.

The procedure and what to expect

  • While in the EMU, your child will undergo EEG monitoring.  During this pain-free test, the EEG technician will attach electrodes to different locations on the scalp using adhesive paste. Each electrode is connected to an amplifier and EEG recording machine. 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.
  • In addition, two small stickers, called EKG leads, will be placed on the chest to observe the heart rhythm and two stickers called EMG leads will be placed on in one hand (may vary) to observe the muscle activity.
  • Once the electrodes are applied, gauze/a cap is wrapped around your child’s head to keep the electrodes in place. Some children may find the process scary at first, but there is no pain. Your child will be asked to lie still because movement can change the results.
  • If the goal of the EEG is to mimic or cause the problem your child is having (like seizures), he or she may be asked to look at a bright flickering light or breathe a certain way. The health care provider performing the EEG will know your child's medical history and will be ready for any issues that could come up during the test.

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 behaviour/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 computer are sensitive to your child’s movements. We strongly encourage the patient to stay in the bed with as little movement as possible during their stay. Some movement for the toilet and short walks can be agreed to, but keep in mind the cameras are focused on the bed and we want to capture a typical event during the admission.
  • We request that one adult stay with your child during the admission to help keep your child calm and entertained and to identify the events or seizures of interest. An event button will be provided to you for this.

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 please make sure the TV is immediately switched off.
  • 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, it is sometimes hard or impossible to find the exact event of interest. Otherwise, please take note of the time and mark it in the event diary afterwards.

When your long-term EEG monitoring is done

  • When the doctors decide it is time for you to go home, the technician will remove all electrodes from your head and body. You have the option to take shower before leaving the hospital if you wish.
  • Once disconnected the nursing staff will guide you through the discharge process.
  • Please note that the reporting process of these studies takes time. We aim to have reports finalised within one week. Please follow up with your neurologist for results. 

Visitors and family members

The EMU staff assistant can assist you with any concerns regarding visitation.