EMU

"She's seizing!"

A voice called into the bustling hospital hall.

That's from my patient's room! I ran down with the others, knowing I would most likely be observing but hoping to help in any way I could. I saw her lying half off her hospital bed, her body rigid, her arms flexed by her side, her head rhythmically snapping back every second, her eyes open but not seeing. The nurses were gently putting her back into bed, but kept her on her side, and the chief resident was quickly preparing lorazepam, a medication that could stop her seizure cold. I held my breath but my eyes still started to water. I needed to hold it together but this was my patient...and even if she wasn't my patient, this little girl was an intelligent, outgoing, young lady who just five minutes earlier was chatting with me about her favorite songs on her iPod.

Within two minutes of receiving her medication, my patient stopped seizing, and within five minutes she opened her eyes weakly. Then, she drifted off as her post-ictal state kept her in profound fatigue and fogginess for the next four hours. When she awoke, she remembered nothing about the seizure, right before or after.

The Epilepsy Monitoring Unit or EMU is a specialty area in the Children's Hospital that I rotated in during my pediatric core. After a child has their first seizure, it is important to determine whether they truly have a seizure disorder or have a health issue that could cause a seizure, such as encephalitis, brain malignancy, or metabolic abnormality, among others. Once we determine the child does not have any unresolved health issue, then the patient is transferred from the inpatient pediatric floor to the EMU, to learn more about them and determine if the patient has an underlying seizure disorder that has made its presence known. The EMU is staffed with nurses and other staff trained in seizure management and epileptologists ~ physician neurologists who received specialized training in seizure disorders.

Within the EMU, patients are monitored 24/7 and have a video EEG, which is a live video feed linked with recorded brain waves of the child in real time. Therefore, while the child is in the EMU, every seizure is recorded and visualized which helps to characterize their seizures and provide accurate information to better treat them. The EMU also has flashing light therapy and sleep deprivation trials as children that have an underlying seizure disorder are more prone than others to have a seizure at a lower level of stimulation. So, bright flashing lights can trigger a seizure in a child with a seizure disorder while a child without a seizure disorder will have no effects from the lights. While it sounds harsh to try to generate a seizure, in the long run, a lot of information is gleaned from seizure activity and it is in a relatively controlled environment with highly trained medical personnel.

My patient did very well in the EMU and I saw her get stronger everyday. While I will probably never know if she ever has a seizure again, she stayed seizure free during her EMU admission and she was discharged home with at least 100 more songs on her iPod.