Cayuga Medical Center’s Epilepsy Monitoring Unit (EMU) has a new director and an expanded program that operates each weekday with advanced neuroscience technology to evaluate adult patients.
The EMU is the only epilepsy diagnostic center in the Southern Tier region. The expanded service will reduce the time patients wait for an evaluation that typically takes about three days of inpatient care at Cayuga Medical Center, says Cynthia Correll, MD, the monitoring unit’s director. She has certifications in neurology, epilepsy, and neurophysiology from the American Board of Psychiatry and Neurology.
Epilepsy affects 1% of the population, and it is one of the most common neurological diseases. Recurrent unprovoked seizures affect physical, cognitive, psychological, and social functioning that characterize the neurological condition, which is a lifelong chronic disease for most patients.
“Despite its prevalence, epilepsy is often misdiagnosed. Not all seizures are because of epilepsy,” Dr. Correll says. “A lot of what we do at the EMU is determine if an earlier diagnosis of epilepsy is correct. Other conditions, such as fainting, sleep disorders, and cardiac arrhythmia, can mimic epileptic seizures. Functional neurological disease, a disorder commonly associated with post-traumatic stress disorder and panic attacks, can cause neurological symptoms like limb weakness, tremor, numbness or blackouts and are misdiagnosed as epilepsy.”
“About a third of patients evaluated at an EMU have a functional neurological disease and need a very different treatment than for epilepsy,” Dr. Correll notes.
Making the correct diagnosis so patients get the correct treatment is a big part of the work at Cayuga’s Epilepsy Monitoring Unit. About 70 percent of patients with epilepsy can manage their seizures with anti-epileptic medicines. The diagnostic workup is done at CMC’s Epilepsy Monitoring Unit and a patient’s pharmaceutical supervised by Dr. Correll or other neurologists at Cayuga Medical Associates.
Of the 30% of epilepsy patients who have seizures despite antiepileptic drug treatment, surgery is potentially curative for many. Strict dietary regimens may also be prescribed for patients with drug-resistant seizures. The EMU at Cayuga Medical Center can perform the diagnostics of patients with drug-resistant seizures. For epilepsy patients needing complex neurosurgery, the Cayuga EMU often refers to UR Medicine’s Epilepsy Center at the University of Rochester Medical Center, but it works with patients wanting treatment at other locations, Dr. Correll says.
Epilepsy surgery options include removing the portion of the brain causing the seizures or implanting a device in the brain that uses electrical stimulation undetectable to the patient that prevents seizures. A third type of surgery consists of a device that is implanted under the skin in the chest and attached to the vagus nerve in the neck. The device delivers electrical stimulation to control a patient’s seizures. Following the out-of-town surgery, patients can find long-term management of their implanted devices from a CMA neurologist.
The renovations at Cayuga Medical Center’s EMU now allow the unit to accommodate up to three adult patients in private evaluation suites. On Mondays, technicians fit patients with electrodes to monitor their brain waves continually, while a video records their movements. If brain activity signals a seizure, the two recordings can be compared and evaluated. Nurses trained in epilepsy care make regular room checks and use a desk station monitor to watch over patients and respond to an alarm that is activated when clinical seizures or other events are occurring. Throughout the monitoring evaluation that could last up to five days, an on-site hospitalist is also available if an EMU patient needs medical care.
Dr. Correll meets in-person or by a digital tele-link with each patient each weekday morning to review the evaluation’s progress and to monitor the gradual reduction in the patient’s anti-epileptic medication that is done to allow a seizure to occur in the hospital setting. She also reviews the day’s brain wave recording looking for the signature of an epileptic seizure.
“The goal for a patient having a seizure in the EMU is to get information to guide the patient’s long-term treatment,” Dr. Correll says.
The EMU staff encourages patients to have a family member or friend stay with them during the evaluation, and a pull-out bed is available for overnight stays. Friends and relatives often recognize early signals of when a patient may have a seizure, Dr. Correll says.
Because of the potential for a 5-day hospital stay, patients are urged to bring books, hobby crafts to work on, a tablet PC, and snacks to supplement what the hospital provides. Patients can have visitors during visiting hours who may bring food or order food delivery.
For more information on the Epilepsy Monitoring Unit at Cayuga Medical Center and Cayuga Neurologic Services, call (607) 273-6757.