Epilepsy Monitoring Unit
The epilepsy monitoring unit at Yale consists of six adult beds, and two pediatric beds, equipped with state-of-the-art closed-circuit video monitoring with EEG (CCTV-EEG). Patients are referred from throughout the world for intensive monitoring for purposes of 1) diagnosis, to differentiate seizures from non-epileptic events (i.e. psychogenic, cardiogenic, pulmonary, and sleep disorders), 2) medication adjustment, and 3) surgical evaluation for refractory epilepsy.
Inpatient monitoring is incorporated into surgical evaluation which is done in several phases. Phase I describes the initial CCTV-EEG monitoring, to both confirm the diagnosis of epilepsy and once confirmed, to characterize and localize typical seizures electrographically. Attempts are also made to obtain ictal and interictal SPECT, PET, ESP-MRI, and neuropsych testing. Phase II includes Wada/cerebral angiography to localize language and memory. Phase III consists of intracranial EEG recording, with either strip, depth, or grid electrodes. Every week there is a multi-disciplinary conference, involving neurology, neurosurgery, neuropsychology, and radiology, where individual patients and the results of their evaluations are reviewed, and recommendations regarding surgical interventions are made.
The residents are an integral part of the epilepsy team, and participate in all aspects of patient care. Responsibilities include admission notes and daily progress notes, analysis of video-EEG, epilepsy clinics, and neurophysiology conferences. While on this block residents also read routine inpatient and outpatient EEGs with an attending.