Pediatric Regional Epilepsy Program: Epilepsy Monitoring Unit (EMU)

In the Epilepsy Monitoring Unit (EMU), we evaluate children who may be experiencing seizures as well as those who have been previously diagnosed with epilepsy. We monitor children using a combination of electroencephalogram (EEG) testing and video/audio recording.

There are two 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

How long your child will need remain in the EMU will depend on your child's condition and the recommendation of his healthcare team. Seizures and events are unpredictable making it difficult to obtain the data needed for diagnosis. Also, 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.

Your child's healthcare team in the Hospital will discuss the progress made each day, and together you’ll decide how long to stay.

Care in the EMU

  • 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.

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.

EMU admission details

  • Patients admitted to 9 South will have a private room. In rare instances, there are no beds available on 9 South, a patient may need to be admitted to a different floor. In this situation, you may not have a private room.
  • 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.
  • 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. Watch our "My Trip to the Hospital for a Video EEG" presentation to help prepare your child for the study.
  • 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.

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.
  • 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.
  • 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.
  • 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.
  • 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.

Watch "My Trip to the Hospital for a Video EEG" presentation to help prepare your child for the study.

Children with behavioral concerns

Please download and fill out the following forms if you feel that your child has any behavioral concerns that you would like to bring to the medical team's attention during your child's appointment:

Caring for your child's 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 your child's study, 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.