Kootenai | Kootenai Health | Issue 4, 2019

For many people with epilepsy, life can feel limited. When you’re unsure of when the next seizure will hit, doing normal activities like driving and running errands can seem daunting or even anxiety-inducing. In order to help providers better treat patients with epilepsy in northern Idaho, Kootenai Health recently constructed a new epilepsy monitoring unit (EMU). An EMU is a unit in the hospital run by epilepsy specialists. These specially designed patient rooms provide in-depth diagnostic and treatment services for people experiencing seizures or epilepsy that may be difficult to diagnose or treat. Modelingexcellence Before constructing the new unit, a team of Kootenai Health neurology experts and nursing leadership traveled to Mayo Clinic in Phoenix to see firsthand how one of the nation’s best epilepsy monitoring units operates. The site visit was beneficial for the team to learn about the design, workflow and safety features necessary for this special unit. “We wanted to model our unit after one that is already very successful,” Cliff Hampton, M.D., Kootenai Clinic Neurology, said. “Mayo Clinic is the best out there. Their unit is dialed in, and their staff was extremely accommodating to our team and willing to share.” Patients and providers are already seeing the benefits of the new unit. John Redmund, a retired dentist from Coeur d’Alene, experienced seizures for many years. As an avid skier and busy father and grandfather, his seizures were interfering with his active lifestyle. Working with his primary care provider, he seemed to successfully manage his epilepsy, but when his seizures began gradually coming back, he sought advice from a specialist. “When I started seeing Dr. Hampton last year he suggested altering my medication, and we did a few tests to see what was going on,” John said. “When we didn’t get the results we wanted, he recommended staying in the new EMU.” Auniqueenvironment Once admitted to the hospital, patients stay in the EMU for five days. While there, patients are typically taken off all epilepsy medication and are monitored 24/7 via electrodes attached to their head. “We actually want the patient to have a seizure while here,” Judy Hayton, Kootenai Health Neurodiagnotics Services manager, said. “We’re trying to see where in the brain the seizures are happening and what the cause may be. We do activation procedures—such as light stimulation, sleep deprivation, and exercise and medication changes—to see what might trigger their seizures.” The EMU has special safety features to ensure patients aren’t harmed if they have a seizure. Every aspect of the rooms and care procedures put patient safety first. “I was the third person to stay in the new EMU,” John said. “It was incredible. I wore a special harness attached to a track in the ceiling so I couldn’t fall. Everyone made me feel comfortable and safe.” John’s wife, Marsha, was encouraged to stay with him during his monitoring. As a former nurse, she said she was impressed with the new facilities and compassion they received from staff members. “Everyone was so responsive and flexible; they anticipated our needs,” she said. “We felt very well- educated and prepared going into this. They really made us feel like we were part of the care team and decision-making.” Unexpected results Toward the end of John’s stay, Dr. Hampton noticed something unusual in his results. It wasn’t something in his brain as they’d expected—it was actually John’s heart rate. At just 28 beats per minute, John’s heart rate was significantly lower than it should be. “If we hadn’t been in the EMU for several days being monitored, this may have gone unnoticed,” Marsha said. “John’s heart rate was always normal during regular doctor appointments and EKGs because he got nervous. It took those several days of being monitored while calm for it to be detected.” Dr. Hampton referred John to Kootenai Heart Clinics, where he underwent additional testing and eventually had a pacemaker implanted to help regulate his heart rate. “Low heart rate doesn’t cause seizures, but it can cause episodes of loss of consciousness via a process called syncope,” explained Dr. Hampton. “Discovering John’s low heart rate drastically altered our plan. The treatment for syncope is very different from the treatment for seizure.” “I feel fantastic. I didn’t even realize how much I’d slowed down until after I had the procedure,” John said. “Without the help of Dr. Hampton and the staff on the neurology unit—and being referred to the cardiac clinic to start this process—I don’t think I’d be doing as well as I am now. I expect to be able to return to skiing with Marsha, our friends, children and grandchildren this season.” KH . ORG 7