Monroe Carell’s Epilepsy Monitoring Unit Charts the Way Forward for Patients

Published on July 6th, 2023 by Jill Clendening.

There’s a button in the Epilepsy Monitoring Unit (EMU) at Monroe Carell Jr. Children’s Hospital at Vanderbilt that’s far more important than the room’s television remote. It’s called the event button.

Pediatric patients as young as infants with known or suspected seizures come to the six-bed specialized unit on the seventh floor of the hospital. There, their brain activity and seizures are monitored 24 hours a day by electroencephalogram (EEG), a recording of the brain’s electrical activity, and by video and audio captured in the room.

Monroe Carell is the only facility in Middle Tennessee with video-EEG monitoring for the evaluation of children for epilepsy.

Tiffany Porter, CNCT, supervisor of the Pediatric Neurodiagnostic Lab at Monroe Carell, is the first person families talk to when they’re referred to the EMU. In a pre-EMU-visit meeting, she talks them through the monitoring process, answers questions and tries to calm any anxiety they might have.

In the first quarter of 2023, around 150 patients had been admitted to the EMU, and typically 650 patients are seen there annually, so it’s a busy space.

“I reassure them that we have some of the best physicians in the world who will be taking care of their children, and that they have great techs to make sure the monitoring is very precise,” Porter said. “Our nurses on the unit are awesome, and we get help from a child life specialist who talks to the family to see if there’s anything they can do to help make the visits nicer for the patient.”

Patients have electrodes placed on their heads and don’t leave their private room during their stay, which can be just 24 hours or a week or more, depending on the complexity and frequency of their seizures. If patients have been taking antiseizure medication at home, the medication is decreased or stopped to allow seizures in the safe setting of the EMU.

Child life specialist Meredith George, MEd, CCLS, works with the EMU team to create informational packets for families to have in the room, and she’s at the ready to supply games, toys, and support that will help children of all developmental ages and behavioral needs get through the process of EEG placement.

A parent or guardian is required to be their constant companion, and meals and a sleeping space are provided. They keep a watchful eye on the child, and if behavior that signals a typical event begins, they push the event button. This sets off a well-rehearsed response.

Neurodiagnostic technicians who monitor around the clock are already watching the child’s EEG record remotely, and they mark concerning patient movements as they occur. These technicians also ensure the patient’s movements are clearly visible on video. The adult caregiver has instructions to uncover the child if they’re in bed and to step back so the camera view is unobstructed.

Should a seizure occur, a nurse experienced in caring for children experiencing seizures responds quickly, checks their vital signs and asks the child, if they are verbal, questions, such as “What is your name?” and “Do you know where you are?”

The EEG detects abnormal electrical discharges in the brain such as sharp or spike waves, typically seen in people with epilepsy. The EEG data, along with the video and audio of the event, help diagnose or rule out epilepsy and determine the next steps of treatment. Recording seizures on EEG allows neurologists to better classify seizures and pinpoint their origin in the brain.

The multidisciplinary pediatric epilepsy team at Monroe Carell, which includes epilepsy specialists (epileptologists), a neurosurgeon, neuropsychologists, neuroradiologists and an imaging physicist, review the data from the EEG and other testing to determine a custom care plan for the child. That plan might include additional testing, a recommendation for surgery, a change in medication or even diet therapy.

Patient Anna Grace Stephens has had several stays at the EMU, beginning in 2016. One of Stephens’ visits coincided with her birthday, so her mother and grandmother decorated the room in a Paris theme, and a nonstop parade of American Girl dolls and accessories helped ease her stay.