The Purpose of EEG / Video Telemetry

     Drug treatment for epilepsy is based on matching the most appropriate drug to a person’s seizure type. Inpatient EEG / video monitoring enables us to gather additional information about the specific types of seizures patients are having. The more accurately we are able to classify the seizure type, the better the chances are to achieve seizure control with medications.

     For people who are having “spells” that cause shaking or other changes in behavior, EEG / video telemetry can often be useful in characterizing such episodes. These “spells” may be seizures but may also be due to other physical or emotional causes, unrelated to epilepsy. Bases on these recordings, we may recommend additional tests or alternative forms of treatment.

     EEG / video telemetry assists us in localizing the seizure focus in the brain. This is critical if patients wish to know if they have the type of seizures that may be treated surgically. Seizure surgery is most successful when we are able to localize the precise area in the brain where seizures originate. Prolonged EEG / video monitoring allows us to record a number of seizures. It may show us that a single focus in the brain is producing the seizures or that more that one area is involved. While a person’s seizures may all look alike, the chances for successful surgery decrease considerably if the seizures originate in more than one area.

An Overview of the Procedure

     EEG / video telemetry has two parts:

1. EEG Telemetry: As during a routine EEG, electrodes are glued to the scalp. However, a continuous EEG recording is made 24 hours per day. A computer monitors the EEG recording continuously so that seizure activity can be marked and recorded even if you are not aware that you are having a seizure. This is very helpful for people who have brief seizures or ones that occur during sleep. This recording gives us an accurate count of seizures and allows us to compare what is physically happening to you during a seizure with what we see on the EEG recordings.


2. Video: A camera is used to continuously film you while you are connected to EEG leads. By using the video we can see what happens to you physically while you are having a seizure. Seeing what happens physically in addition to evaluating the EEG recoding during an event helps us to accurately classify the seizure type.

Admission to the UCSF Telemetry Monitoring Unit

     The telemetry unit is located on the 8th floor of the Long Hospital. Looking around the room, you will see a camera mounted to the wall, opposite the head of your bed. In addition, there is a dim light over your bed, which allows us to film at night. The camera remains on throughout your admission so that we can observe any seizure activity. You will have a single bed, a chair that converts into a bed, a telephone, television with VCR, and a private bathroom. You will be asked to stay in your room at all times, in order to remain in camera range. The EEG electrodes are attached to a 20-foot cord so that you will be able to get out of bed and got to the chair, sink, or bathroom.

     You will find an alarm button attached to a cord and clipped to the padded siderail of your bed. This is probably the most important piece of equipment with which to become familiar. When you squeeze it, an alarm goes off in the nurses’ station. It also alerts the computer to mark and save what follows on the video and EE. If you have any warning (aura) before your seizures, you should push the button. If you do not have warnings or auras prior to your seizures, it is helpful to have a friend or family member stay with you so that he or she may push the button for you. If this is no possible, please notify the Epilepsy Center Office before your admission to the hospital.

     For any “strange” feeling which you think might be a seizure, you will also be asked to push the alarm button. The computer is set to help detect seizures and also mark the EEG. However, it is very important that you take an active role in helping us identify you seizures. You may get a feeling before changes occur in your EEG. By pushing the button, we are able to record the entire event and your nurse will hear the alarm and come in to do a neurological examination with you both during and after the seizure.

     After you are admitted to the hospital, you will be “wired up” with EEG electrodes glued to your scalp. The wires go into a receiver unit, which is hooked up by cables to the computer. Every day the electrodes are checked by the EEG technician, to make sure all the electrodes are working correctly. The electrodes are not removed until the testing is complete. Because of this, you will not be able to change clothes that fit over your head. Most people find it easiest to ware the “tie in the back” hospital gowns, but you can wear your own pajama tops if they button or zip up the front or back. Because you will be on camera, we asked that you wear pajama bottoms, underpants or shorts at all times. You will not be able to wash your hair until the electrodes are removed just before you go home.

     Your antiepileptic medicines may be slowly decreased during your admission. We do this to try to bring on a seizure. You will be under medical supervision during this time so that you need not worry about safety during a seizure. Do NOT taper your medications on your own before coming into hospital.

     An intravenous catheter will be placed in your arm and capped. This is for your safety. If you have very severe or frequent seizures, we will stop the seizure by using this catheter to give you intravenous medicines. This is checked daily by a nurse and changed as necessary.

     You may have a “regular” EEG during your stay. For this test the technician will bring an ordinary EEG machine to your bedside and do a routine EEG recording, or take you down to the EEG lab to have it done.

     You might be sleep-deprived during your admission. Lack of sleep can bring on seizures in some people. You may ask a family member or friend to stay overnight with you to help you stay awake. If exercise or fatigue helps bring on your seizures, you might be asked to exercise. Pads can be put on the floor of your room and you may use the rowing machine or walk around.

     If we are not able to get enough information with the scalp electrodes, we may need to place a special type of electrodes called sphenoidal electrodes. These are very thin wires that are inserted just above the jaw with a needle. The needle is then removed and the wire stays in place. These special electrodes give us more information about seizure activity, especially if it is arising from the temporal lobes. If we feel these special electrodes are necessary in your case, we will discuss this option with you in the hospital.

     Visitors are allowed 11 A.M. to 8 P.M. daily. You are allowed to have one family member or friend stay with you overnight. If someone will be staying with you while you are hospitalized, the hospital will provide a cot for this person at no additional charge. Meals for your guest may be purchased at the hospital cafeteria. There is a refrigerator and a microwave on the unit that you may use if you desire to bring additional snacks or meals.

     More than 3,000 people with uncontrolled seizures have been monitored at UCSF since the telemetry unit was established in 1986. Of these, the majority was diagnosed with epileptic seizures and more than half of them left UCSF with a new plan for medication management based on an understanding of their specific seizure type.

     Should further EEG monitoring studies, seizure surgery, or participation in an investigational anti-epileptic drug trial be recommended as possible options for you, the specifics of each option will be discussed with you in detail prior to your discharge from the hospital or in follow-up clinic appointment at the Epilepsy Center.