Pediatric Regional Epilepsy Program

Inpatient Admission to the Epilepsy Monitoring Unit (EMU)

There are 2 common reasons for admission to the EMU:

• To record an episode in order to determine whether or not the episode is a seizure.
• To record brain waves (and often seizures) in a patient with known epilepsy in order to guide treatment.

EMU admission process

• On the night before admission, the bed management team/admissions office will contact you by phone and tell you when to arrive at the Hospital.
• The exact time of the admission cannot be determined in advance, because it is dependent upon the time patients are discharged on your scheduled day.
• If you are going to be later than your scheduled time, you must call the EMU directly so that we can coordinate your arrival time with other patients. If you are late and haven’t called us in advance, 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 main hospital. You will be registered and then directed to your room on 7 west.

Care in the EMU

• The EMU is located on 9 South, and most patients undergoing EEG monitoring stay on that unit. Rarely, patients have to be admitted to other floors if there isn’t a bed available on that unit. We have portable EMU machines and the data we gather on other units is no different than if the patient had a room on 9 South.
• While in the EMU, your child will undergo EEG monitoring. EEG wires will be attached to your child’s head. The EEG data is recorded continuously during this time. The wires are long, and your child will be able to move around the room. Patients do not need to remain in bed.
• While in the EMU, your room will undergo video surveillance. The video is linked to the EEG, so we can compare your child’s brain waves to their behavior and movements. Please note the location of the camera in your room. If your child has an episode of unusual movements or a seizure, please do not block the camera or we will not be able to see your child on video.
• The EEG data is reviewed several times per day. The neurology team will discuss the plan with you when you are admitted. You will be given results of the EEG each morning between 10 a.m. and noon during in-patient rounds.
• The EMU is a multidisciplinary team consisting of many specialties. Depending on the needs of your child, the team may include EEG technologists, pediatric residents, neurology fellows, an attending neurologist, nurse practitioners, nurses, psychiatrists, psychologists, social workers, and other specialists. A Child Life Specialist will participate in your child’s care to help coordinate recreational and bedside activities. CHOP is a teaching hospital so may meet medical, EEG and nursing students who are under the supervision of experienced staff.

Your role

• We request that one adult stay with your child during the admission to help identify the spells or seizures of interest. When you need a break from your child’s room, please let us know so that the nurse can coordinate alternate coverage.
• 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 have recorded the event you see at home.
• Parents have 24 hour visiting privileges. Visiting hours for other visitors is from 9 a.m. to 9 p.m. Every room has one parent sleep chair at the bedside. Although both parents can stay overnight, we can only provide one sleep chair. Siblings are not permitted to stay overnight. We discourage you from bringing infant visitors as they may be exposed to viruses that may cause them to become sick.

EMU admission details

• Once your child has been admitted to the floor, the EEG electrodes will be applied by an EEG technologist and the EEG and video data will start to be collected. The monitoring equipment simultaneously records the brain waves, video and audio of your child.
• 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.
• 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 things we may not be able to see on the video.
• Push the event button. The EEG technologist will show you a button in your room. Pushing this button marks the event on our recording, and allows us to find the event. If you don’t push the button, we may not be able to find the event of interest.
• Write down the time of the event and a detailed description of what you see. The EEG technologist will provide you with a paper to use to record details about the event.

If you have any questions, please call the EMU at 215 590- 2775.

Frequently Asked Questions

Will I have a private room?

Patients admitted to 9 South will have a private room. In rare instances, there are no beds available on 9 South and a patient may need to be admitted to a different floor. In this situation, you may not have a private room.

Do I have to stay awake all night to watch my child?

No, however we ask that when your child is awake that you remain awake to help identify the events. You don’t need to stay awake when your child is asleep.

How do the electrodes get applied?

Your child must remain still and in a flat position for a short period of time for the electrodes to be successfully and accurately applied. Sometimes we use a medical immobilizer to keep your child from moving and to ensure their safety. We apply the electrodes with an adhesive called collodion. The collodion is dried with a small air compressor. The air compressor is noisy, but 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 dressing to children. Some children may find the process scary at first, but there is no pain with the procedure. We work closely with Child Life Specialists to make your child as comfortable as possible.

Do you use sedation to put electrodes on the head?

No, we do not use sedation. While it may be upsetting for children, it is not painful. Also, sedation may reduce the chances of capturing your child’s event and may alter your child’s brain waves which could make it hard for us to interpret the EEG.

How often does the head dressing need to be changed?

The head dressing will be changed every day to replace the electrode gel to maintain a high quality recording. Sometimes we need to replace the collodion adhesive on some electrodes.

How can I help prevent my child from pulling off the electrodes?

We wrap the head and the electrodes using cotton gauze in a pony tail fashion, and this usually keeps the electrode in place. We also ask that you watch your child and do not allow pulling on the head wrap. By redirecting your child with toys, books, activities or movies, we can usually succeed without further restraints.

Does my child have to remain in bed during the study?

Absolutely not! The video equipment allows your child to move about the room. We encourage a regular environment so that the events may occur naturally, just as they would at home.

When will I know the results of the study?

The neurology team will tell you the results of the EEG during daily morning rounds which are typically between 10 a.m. and noon.

How many days will my child stay in the hospital?

Seizures and events are unpredictable making it difficult to obtain the data needed for diagnosis. The goal of each child’s admission is different. Some children are here to capture one event while others need to have several events recorded on video-EEG. The goal for your child’s admission should be discussed with neurology. The healthcare team you meet in the hospital will discuss the progress made each day, and together you’ll decide how long to stay.

What should I bring to the hospital? 

We encourage you to bring favorite toys, books, school work, and DVDs. We have a TV and a DVD player in every room. Sony Playstation 2 is also in the majority of patient rooms, but not all. We have a large selection of toys, board games and crafts in our playroom that we can bring to your child.

How do I care for the scalp/skin after electrode removal?

You may notice marks on your child’s head once the electrodes are off. The severity of the marks depends on the length of the time the head was being monitored and your own child’s skin texture. Fair or thin skinned heads tend to have areas that have the greatest percentage of indentations left behind. You may notice the shape of the gold electrode on the forehead area, redness, puffiness and even slight blisters/scabs. This is all from having the electrodes on the head and being wrapped. No air gets in. This is normal. The longer the study is, the more severe the area may look. Do not rub the irritated area gently blot dry. We suggest using Neosporin on the areas in question. The marks can take up to 2 weeks to vanish. Of course if you still have concerns, please call your pediatrician.