Epilepsy Monitoring Services at UPMC

If you have epilepsy and/or experience frequent seizures, a stay in an epilepsy monitoring unit (EMU) can help your care team assess your condition more effectively.

Neurologists and epileptologists refer patients to the EMU for evaluation. During their stay, patients are monitored 24/7 by specially trained staff who gather information about their seizures, what's causing them, and their severity. EEG and video technology collects data before, during, and after seizures.

EMU testing can help provide a more thorough assessment of your condition and help us develop an individualized treatment plan.

The UPMC Comprehensive Epilepsy Center is a national leader in treating epilepsy. Our epilepsy monitoring units use industry-leading technology and are staffed 24/7 by teams specially trained in epilepsy care.

What Is an Epilepsy Monitoring Unit?

An epilepsy monitoring unit (EMU) is a specialized unit that evaluates patients' epilepsy and seizures. Patients stay there as seizures might be provoked as needed by tapering medications and using various triggers.

The goal is to collect information about which area of a patient's brain is causing seizures and how severe their condition is. That enables us to recommend future treatments, such as new medications or surgery.

The epilepsy monitoring unit can:

• Assess a patient's response to medications and adjust medications as needed.
• Confirm a diagnosis of epilepsy.
• Determine what type of seizures a patient has and which area of the brain is causing them.
• Evaluate patients to see if they are candidates for surgery.
• Provide data for surgical planning.

Who's Eligible for Epilepsy Monitoring?

Patients must be referred to the epilepsy monitoring unit by their neurologist or epileptologist — an epilepsy specialist.

Epilepsy monitoring is the gold standard for classifying epilepsy and seizure events. It can help provide your care team with answers about your epilepsy. It can also help your team create or adjust your treatment plan.

Eligible patients for epilepsy monitoring may include those with:

• Drug-resistant (refractory) epilepsy patients — Refractory epilepsy occurs when a patient continues to have seizures despite trying two appropriately dosed medications. The epilepsy monitoring unit can help determine the next course of treatment.
• Epilepsy diagnoses — The epilepsy monitoring unit can help confirm or deny a diagnosis of epilepsy.
• Frequent seizures — People who have frequent seizures at home may be referred to the EMU to adjust and optimize their medication in a safe environment.
• Functional neurological disorders — Functional neurological disorders are conditions that can cause seizure-like responses, but they are not actually epileptic seizures. Some patients with these disorders may be misdiagnosed with epilepsy. The epilepsy monitoring unit can help provide a correct diagnosis and determine an appropriate treatment.
• Pregnancy or planning a pregnancy — Some pregnant women with epilepsy face a higher risk of health issues or adverse pregnancy outcomes. Antiseizure medication dosages often need to be adjusted during pregnancy and right after birth. In addition, some antiseizure medications are safer than others during pregnancy. The epilepsy monitoring unit can help their care team adjust their medication as needed to ensure the mother and child's safety.
• Presurgical patients — The EMU can evaluate patients to determine the source of their seizures and whether they are candidates for surgery. The EMU can also map the brain to determine if the seizure onset zone can be safely removed.

What Epilepsy Monitoring Services Do We Offer?

The epilepsy monitoring unit may use various tests and procedures to:

• Confirm an epilepsy diagnosis.
• Diagnose the type of epilepsy.
• Identify the seizure onset zone.
• Prepare a treatment plan.

Diagnostic services and procedures

The primary diagnostic test in the EMU is a video electroencephalogram (VEEG). The EMU team attaches electrodes to patients' scalps to monitor their brains' electrical activity. The VEEG also records high-definition video of the patients to observe the physical effects of a seizure.

Combining brain and video monitoring provides the most complete picture of a seizure's neurological and physical manifestations. The VEEG captures data before, during, and after the seizure. It also has night vision capabilities, allowing video to be recorded in low-light conditions.

Other diagnostic testing that can take place in an EMU include:

• Intracranial EEG — This procedure places electrodes into the brain to measure electrical activity. It can help identify a seizure onset zone and determine if it can be surgically removed.
• MRI — MRI produces detailed images of the brain by using a combination of powerful magnetic fields and radio waves.
• Neuropsychological testing — This involves an interview and psychological tests. It can help determine a brain condition's impact on your behavior, mood, memory, and more.
• Single photon emission computed tomography (SPECT) scan — A SPECT scan shows changes in the blood flow in your brain. A radioactive dye is injected into the bloodstream; the dye lights up during a CT scan. SPECT scans can help determine where a seizure began in the brain.

Treatments

While in the EMU, the team may taper patients' existing medications and use other triggers to provoke seizures. They also may start patients on new medications to see whether the drugs can better control their epilepsy.

What Can I Expect?

Preparing for your visit

Patients are referred to the epilepsy monitoring unit by a neurologist or epileptologist. Before going to the EMU, you will receive information about what to expect during your visit. You also can talk to the EMU team to tell them your health history and ask questions about your EMU stay.

An average stay in the EMU is three to five days, but it could be shorter or longer, depending on your specific case. With that in mind, it's important to pack essentials and comfort items for your stay. Consider bringing:

• Comfort items such as a blanket, stuffed animal, and more.
• Comfortable clothes/pajamas.
• Entertainment items such as books, magazines, puzzles, a laptop, smartphone, tablet, and more.
• Snacks.
• Toiletries.
• Your current medications.

Also, you should arrange transportation to the hospital on the day of your admission and home from the hospital after your discharge.

While in the epilepsy monitoring unit

Ask your care team if you should take your epilepsy and other medications as usual on the day of your EMU admission.

After the admission process, a member of the EMU team will take you to your room. Each EMU patient will have a private room and bathroom during their stay.

While in the EMU, nurses and other staff will be available at all times to help you with your needs. You should not do anything — even go to the bathroom — while unattended because of the risk of seizure. You will have a call button to ask for assistance.

To begin the monitoring process, the EMU team will attach electrodes to your scalp. This allows the team to monitor your brain's electrical activity with EEG. They will take a baseline measurement of your brain activity early in your stay.

During your stay in the EMU, the team will taper off your medications in an attempt to make a seizure more likely.

They may also try other seizure-provoking techniques, such as:

• Hyperventilation.
• Partial sleep deprivation.
• Photostimulation.

EMU nurses and other staff are specially trained to respond when seizures occur. Patient safety is the top priority during your stay. Other safety protocols include safety rails and padding on patient beds.

While in the EMU, you may wish to read, watch television or movies, work, and more. This can help make the stay easier. You also are permitted to have visitors.

After your EMU stay

The average stay in the EMU lasts three to five days. However, depending on your specific case, it may be shorter or longer.

Before your discharge, the EMU team will reintroduce your antiseizure medications. During your stay, they may also introduce new medications to help control your seizures.

It's ideal to have someone stay with you for a few days to assist with your recovery after your EMU stay. Ask your care team which activities to limit once you're back home and when it is safe to return to your normal routine.

You will have a follow-up appointment with your neurologist shortly after your EMU stay. You can go over your EMU results, review your medications, and discuss the next steps in your treatment.

Why Choose UPMC for Epilepsy Monitoring?

The UPMC Comprehensive Epilepsy Center is a level 4 epilepsy center — the highest ranking given by the National Association of Epilepsy Centers (NAEC). We are a referral center, taking on challenging cases that other epilepsy centers do not. We also are a leader in research, including leading and participating in clinical trials.

At UPMC, you can expect:

• 24/7 monitoring — UPMC's epilepsy monitoring units are staffed around the clock by a dedicated team of physicians, nurses, technicians, and other professionals. We monitor patients at all times and assist them with whatever they need. Patient safety is paramount.
• Comfortable care — Our epilepsy monitoring units are designed with patients' comfort and safety in mind. Each patient has a private, spacious room, including a private bathroom. Beds are equipped with padding and rails to ensure your safety.
• Experienced care teams — UPMC's epilepsy monitoring teams are specially trained to care for epilepsy and seizures. We have years of experience in monitoring epilepsy and responding to seizures.
• Leading technology — UPMC's epilepsy monitoring units are equipped with industry-leading technology, including cutting-edge EEG brain monitoring and video monitoring to capture physical seizure responses. This allows us to get the clearest answers about your epilepsy and seizures.

By UPMC Editorial Staff. Last reviewed on 2025-03-19 by Alexandra Urban, MD.