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Epilepsy is a term used to describe a number of neurological conditions caused by abnormal electrical discharges from the brain (seizures).

Seizures may vary in their cause and clinical manifestations. In some cases it is not clear what is causing them, and a detailed history or reliable account of an event by an eyewitness is not always available.

One of the characteristics of epilepsy is the unpredictability of seizures, and despite many advances in diagnosis, classification and treatment, it is often not clear why seizures occur when they do, and in some cases non-epileptic events may be difficult to distinguish from seizures.

Prolonged or continuous monitoring of the electrical activity of the brain (EEG) would be helpful, but until recently this has been difficult to achieve. Seizure activity may only occur periodically or in clusters when EEG monitoring is not being carried out. In some cases patients are not aware of their seizure activity or are unable to report their feelings reliably.

For this reason, Ambulatory Electroencephalography has been developed to monitor brain activity over longer periods of time, very much like a Holter monitor is able to track the electrical activity of the heart for ambulatory patients.

One drawback of this procedure is that it is not always able to correlate the behavior of the patient by direct observation with the tracings on the electroencephalogram (EEG). Therefore, a new technique has been developed that combines video monitoring with the EEG under the direct supervision of trained clinical personnel.

This technique is carried out in an “epilepsy monitoring unit” (EMU) under the direction of a neurologist, Dr. Irina Kogan, and a supporting team of health professionals. Certain patients would benefit from referral to an EMU, including those with difficult to diagnose seizures, those who are not responding well to treatment, and older patients with recent-onset seizures.

Since defining some seizures may require the withdrawal of medication, it is important that such patients be in an epilepsy monitoring unit (EMU) to ensure their safety. The EMU also allows continuous video and audio recording in addition to EEG, and direct interaction with staff in case adjustment of medication or other intervention is necessary.

Irina Kogan, MD