Long-Term Video-EEG Studies: EMU vs. In-Home
Long-term EEG studies can take days or weeks to schedule and complete, and studies taking place in the Epilepsy Monitoring Unit (EMU) come with increased risk in today’s circumstances. The COVID-19 pandemic has tightened restrictions in hospitals everywhere. For many patients, (in particular, those who only require scalp EEGs and are not having their antiepileptic medication withdrawn) the future of EEG studies is no longer in hospitals, but in the patient’s home. The safety, comfort and efficiency afforded by in-home ambulatory video-EEG studies are more necessary now than they ever have been before.
Safety During COVID-19
While hospitals are canceling elective procedures to avoid the spread of COVID-19, it makes sense to use all available technology to keep contact to a minimum. The more patients can avoid potential exposure to COVID-19 cases, the better we can control this outbreak. In-home EEG monitoring keeps the patient out of the hospital, limiting exposure to usually one EEG Technologist, while delivering the same high-quality diagnostic recordings one would receive in an EMU.
The EEG Technologists providing home-centered EEG services follow CDC guidelines, using appropriate personal protective equipment (PPE) and proper infection control procedures, which includes having the patient wear a proper face mask.
During this uncertainty caused by coronavirus, home-centered EEG services can aid hospitals and patients in safe and effective ways.
Consistent, Comfortable Care
The many advantages of in-home ambulatory EEG monitoring start with consistency. In a study published by the British Epilepsy Association, it was found that 73% of in-home EEG recordings were able to provide enough information to answer diagnostic questions; in-hospital EMU EEG units provided the exact same performance, 73%1. Having a consistently reliable recording is the bedrock of successful patient evaluation and treatment, and adds a level of confidence for both doctors and patients.
An obstacle with increased EEG testing is that qualified EEG Readers are often in short supply. CortiCare offers reliable remote monitoring and EEG reading services through a nationwide network of neurophysiologists and epileptologists. With technology that supports remote access to real-time EEG recordings in the home, EEG Technologists and EEG reading physicians can view the video-EEG study at any time and generate a daily report and/or a summary report at the end of the study.
In the study cited above, after their monitoring was finished, patients were asked whether they would prefer EMU or in-home monitoring. Of those patients who were monitored in the hospital, 45% expressed that they would rather be at home for the process. 80% of those who were monitored at home said they were glad for it. Reasons for this preference ranged from an increase in comfort, to ease of childcare and a dislike of hospitals1.
Being in a hospital can put as much stress on a patient as it can on their doctors and nurses. A busy EMU, or just a hospital-like environment, can trigger the “hospitalization anticonvulsant” effect. This well-known phenomenon can reduce the likelihood of capturing seizure events during the stay in the EMU and could delay a correct diagnosis. Monitoring a patient in their home can increase the chances they will experience the triggers for their convulsive behavior, allowing EEG recordings to gather the necessary information to properly diagnose and treat the patient. Therefore, the added comfort of an in-home video-EEG monitoring study can also improve the productivity of the study as well.
The Technology
A benefit of EMU EEG monitoring is access to data in real time, delivered straight to technologists and epileptologists. That was a benefit exclusively owned by the EMU and in-patient monitoring until advances in EEG recording and remote monitoring technology enabled the evolution of ambulatory EEG services. Now, ambulatory EEG supports remote, real-time access to live video-EEG recordings in the home. CortiCare’s real-time monitoring services are available to make sure that an EEG Technologist can send quick messages to the reading physician if a significant EEG event is seen during intermittent or continuous remote monitoring of the study. CortiCare’s services include full disclosure video-EEG recordings and an online review option with a Registered EEG Technologist.
Current video-EEG digital recording technology supports remote connections via 4G cell phone services and even through secure connections using a patient’s Wi-Fi router. CortiCare takes advantage of this technology to produce clean, reliable EEG recordings with digital video in the patient’s home, that can be monitored remotely from almost anywhere to ensure a high-quality study is captured.
The fact that ambulatory EEG monitoring is real-time, with no delays, makes this a compelling alternative to costly EMU stays. The less time a patient needs to stay in an EMU, the lower the cost to our healthcare system. However, less time in a hospital does not mean less care. Patients receive efficient monitoring at home and doctors receive the clinically useful data, in most cases, to make a diagnostic judgement.
When comparing in-home ambulatory and EMU EEG monitoring, both are valid and effective ways to evaluate patients. However, in-home EEG monitoring offers a lower overall cost, with greater safety in a pandemic, while addressing most diagnostic questions.
References
1 Kandler R, Ponnusamy A, Wragg C. Video ambulatory EEG: A good alternative to inpatient video telemetry?. Elsevier, 2017.