Epilepsy Monitoring Units (EMUs) in America
An Epilepsy Monitoring Unit (EMU) is a specialized unit where patients are admitted for 3-7 days. During this time, the patient undergoes continuous monitoring of their brain activity using EEG and video recordings.
How many EMUs are there in America?
The National Association of Epilepsy Centers (NAEC) offers an accreditation program to ensure that epilepsy centers follow standards of care and a set of evidence-based guidelines.
According to NAEC, there are more than 260 EMUs in the United States. More highly populated areas are more likely to be closer to an EMU, while others may find themselves farther from an EMU. However, the NAEC is consistently recruiting new centers for their accreditation, meaning the number of EMUs across America will only continue to increase.
The NAEC offers a complete list of epilepsy centers under their membership listed by state, and there is also a map view available to see how far away the center may be.
A 2020 study compiled a group of patients choosing to complete outpatient follow-up visits via telehealth to better envision the distance some patients may have to travel to an EMU. Of those who opted for this choice, 26.7% of patients were local (<= 50 miles), 30.5% were near regional (51-150 miles), 20.1% were far regional (151-270 miles), and 22.7% were remote (>270 miles). So, patients seeking epilepsy treatment are pretty evenly split among these four categories, emphasizing that some patients are close to an EMU while others may be quite far.
What is it like in an EMU?
An EMU allows the physician to assess seizure activity, which can help diagnose the seizure. In many cases, unless the patient has a seizure while visiting with a doctor, it can be challenging for the doctor to understand how the seizures affect the patient’s brain and body.
The length of stay can vary from 3 to 7 days based on the center and how many seizures have yet been recorded.
While in the EMU, the patient will stay in a private room that typically contains enough room for a loved one as well. The patient must remain in the bed or a chair during all monitoring times. This rule serves two purposes; the first is the safety of the patient when they have their seizure, but it also ensures that the video records all seizure activity when it occurs.
As expected, remaining in bed or sitting for days on end can become boring, so it is advised for patients to bring something to help pass the time, including games, books, puzzles, or other activities that can be done in one place.
When preparing to go to the EMU, patients should wear regular and comfortable clothes, and the one requirement is that all shirts be button-down or zip-front.
Electrodes will be attached to the scalp to record the EEG, and since the electrodes must remain dry, the patient cannot shower during the duration of their stay. An IV will also be inserted in the arm so that the staff can safely deliver any needed medications.
Cost of an EMU compared to outpatient care
The average cost of a stay in an EMU is $35,000 to $40,000, but some insurance plans will cover the stay, although they typically require preapproval. The cost of the procedure also varies based on the length of stay and location used.
Other locations may cost $3,000 for EEG monitoring and video monitoring for 24 hours, which provides an average cost per day only for the EEG monitoring and video recording. This does not include the cost of the bed, meal, and other services provided during the stay.
In comparison, a standard routine EEG is typically $200-$700, while an EEG with extended monitoring can be up to $4,000. It is crucial to remember that these costs are solely for the test itself and not any doctor's fee.
References
All Epilepsy Center Locations - National Association of Epilepsy Centers. (2022). Retrieved 7 April 2022, from https://www.naec-epilepsy.org/about-epilepsy-centers/find-an-epilepsy-center/all-epilepsy-center-locations/
Fesler, J. R., Stanton, S., Merner, K., Ross, L., McGinley, M. P., Bena, J., Rasmussen, P., Najm, I., & Punia, V. (2020). Bridging the gap in epilepsy care: A single-center experience of 3700 outpatient tele-epilepsy visits. Epilepsia, 61(8), e95–e100. https://doi.org/10.1111/epi.16619
Agrawal, S., Turco, L., Goswami, S., Faulkner, M., & Singh, S. (2015). Yield of Monitoring in an Adult Epilepsy Monitoring Unit (P2.097). Neurology, 84(14 Supplement). Retrieved from https://n.neurology.org/content/84/14_Supplement/P2.097
Electroencephalography (EEG) Prep, During, After, Results, Cost. (2022). Retrieved 7 April 2022, from https://www.emedicinehealth.com/electroencephalography_eeg/article_em.htm