Johns Hopkins Neurology has two specialized epilepsy monitoring units: one for adults and another for children.

High-Tech Evaluation to Help Tailor Epilepsy Treatment

Epilepsy, seizures and seizure-like disorders can be challenging to treat. Every person with seizures is different, and the best treatment may include medication, stimulation techniques, diets or surgical procedures.

Identifying the most appropriate treatment plan for each patient starts with a thorough evaluation and diagnosis. The EMU team uses computer-based monitoring equipment designed for the evaluation of seizure disorders to gather data before a seizure starts, while one is occurring and during seizure recovery.

This approach can provide answers about your seizures’ characteristics and help doctors identify the type(s) of seizures and other clues that can shape your treatment.

A Multi-Specialty Team for Epilepsy Diagnosis

The EMU brings together experts who have specialized training in patient care and technology needed to meet the unique needs of people with epilepsy.

Your EMU team may include Johns Hopkins neurologists, neurosurgeons, nurse specialists, EMU technologists, clinical technologists, epilepsy fellows, neurology residents, medical students, nursing students, psychologists, psychiatrists, dietitians, case managers and social workers to cover all aspects of your life affected by seizures.

The EMU has a primary nurse and an operations manager, who assists in planning and coordination of care before patient admission.

Behind the scenes, EMU technologists and biomedical engineers supervise the functioning of the high-tech monitoring equipment.

Your Stay at the EMU

Planning

Before being admitted to the EMU, you will likely have an outpatient consultation with a neurologist or neuropsychologist at Johns Hopkins. Alternatively, your outpatient neurologist may refer you to the EMU. If you have an outpatient neurologist outside of the Johns Hopkins system, we may recommend that you see one of our neurologists before coming to the EMU. 

The length of your stay in the EMU depends on what your tests reveal, the frequency of your seizures and other factors. Most people stay at the EMU between three and seven days. After you leave the EMU, you may need to remain in the hospital for a day or two so the team can adjust your medications and ensure you are safe to return home.

If you are taking medications to control your seizures, you may be instructed to temporarily reduce or gradually stop the medications during the EMU stay. This allows the EMU staff to record and analyze your seizures while they are happening. You will be safe under observation at all times in the EMU. Be sure to discuss any concerns with your doctor and nurse coordinator.

What to Bring

• A sleep mask that it ties at the back of the head
• Your continuous positive airway pressure (CPAP) machine or other home medical equipment (Please let the EMU staff know in advance if you need these items, as they will need to be inspected by Clinical Engineering when you arrive)
• All your medications and supplements. After a medical review of all your medicines, we will store them safely and dispense them to you or ask a family member or care provider to take them home. Please do NOT bring medical marijuana or other cannabis products onto Johns Hopkins property as they are strictly prohibited.
• Loose-fitting clothing, including shirts and tops that button in the front: no pullovers or t-shirts
• Personal care items
• Books, games, crafts
• Favorite toys and blankets for children

Arriving at the EMU

On the day and time of your appointment, you will check in at The Johns Hopkins Hospital's main admissions office. The admission process may take two hours or more. Please take your prescribed morning medications on the day of admission unless instructed not to by your physician.

Once you have completed the registration process in the admissions office, you will be given directions to the unit. Each patient at the EMU has a private room and bathroom with a toilet, sink and wash basin. You will not be allowed to shower when wearing electrodes on your scalp or with surgically implanted electrodes, because your head must stay dry. After monitoring is completed and the electrodes are removed, you may shower.

Tracking Your Seizures at the EMU

While you are in the EMU, you will be recorded on video and by using computerized electroencephalogram (EEG) monitoring equipment, which will be connected to your scalp 24 hours a day, recording your movements, speech and brain waves. We understand that this can feel invasive or bothersome to some people, but it is the best way to keep you safe and to capture information about your seizures, which is necessary to optimize your treatment plan. You will not be recorded on video in the bathroom.

You will have a button at your bedside that can be pressed to alert the staff when you feel a seizure coming on, including any auras if you tend to experience these before your seizures. If you have a seizure, you or your visitors can press the button and verbally describe what is occurring. Microphones in each room will ensure that the team can both hear you and record the seizure event.

Distinguishing Functional Seizures from Epileptic Seizures

Functional seizures, also sometimes referred to as psychogenic non-epileptic spells (PNES), are a subtype of functional neurological symptom disorder. People experience functional seizures in the form of attacks, episodes or spells. Functional seizures can look like epileptic seizures and can include altered consciousness as well as sensory or motor symptoms. 

Differentiating functional seizures from epileptic seizures can be challenging and is best done through long-term video EEG monitoring, as provided in the Johns Hopkins EMUs. Functional seizures are diagnosed if the tests show the presence of specific seizure symptoms without abnormal EEG or other medical causes.

Patients seeking an evaluation for suspected functional seizures can request an EMU evaluation by obtaining a referral from a neurologist.

If the EMU stay confirms functional seizures, there are several options for treatment:

• The Functional Neurological Disorder Clinic at Kennedy Krieger Institute is an outpatient treatment program for children ages 5-25.

• Johns Hopkins Functional Disorders Program can help connect adults (18+) who have functional seizures with several inpatient and outpatient treatment programs at Johns Hopkins.

Visitors and Family Members

We encourage family and visitors to spend as much time with the patient as they wish. Please refer to the Johns Hopkins care partner and visitor policy for the most up-to-date information about visitation. The EMU nurse coordinator and EMU staff assistant can also help you with any concerns regarding visitation. 

Please note: For patients under age 18 or any patient with special needs, one adult family member is required to stay with the patient for the duration of their stay in the EMU. Please discuss these arrangements with the EMU nurse coordinator or EMU staff assistant when scheduling an admission.