Epilepsy Center

The HIMA•San Pablo Hospital creates the first Epilepsy Center in Puerto Rico. The unit has six rooms to monitor seizures -24 hours- with cameras and electrodes on the patient’s head, and a team of specialists in epilepsy.

This technology is known as Video-EEG (VEEG) with Telemetry. This study is essential for the evaluation of patients with epilepsy, especially difficult to diagnose or do not respond to medication indicated. It is essential in the presurgical evaluation of patients with refractory epilepsy medication, useful in differentiating epileptic seizures fundamental to evaluate patients with sleep disorders non-epileptic seizures (pseudoseizures) and it is fundamental to evaluate patients with sleep disorders.

The fundamental objective of VEEG is to obtain simultaneous recording of the electroencephalogram (EEG) and patient behavior during seizures, obtaining clinical and electrical sequence of the crisis that allow us to identify the region or hemisphere onset of epileptic discharge. Moreover it makes possible to observe details of the semiotics of the crisis to identify the kind of the patient’s crisis.

Intensive Monitoring Unit

 Our unit consists of a monitoring center where a doctor and a technician control permanently EEG activity and the patient. Direct observation is through a glass and indirectly through TV monitors in a closed circuit.

Patients are placed in single rooms with permanent assistance. The HIMA•San Pablo Caguas Hospital has 6 rooms that allow you to monitor and record 6 patients simultaneously. The recording equipment has 4 video cameras located in each room and that are managed by remote control from the center.
The cameras must have the functions of pan, tilt, zoom, focus and color. These functions allow shooting with details specific parts of the patient’s body and sequential crises that eventually arise. Zooming and quality focus allows the identification of subtle details during the crisis. A second monitor CCTV, is located in the patient’s room so that the technician can control the quality of the recording, check the electrodes and interact with the patient during the crisis. This second monitor is also useful when you want to administrate an early intravenous injection to obtain an ictal brain SPECT carried out in patients potential candidates to perform epilepsy surgery.The patient has available a button (event marker) to press at the time to feel an aura that evokes the beginning of the crisis. The button has an alarm that sounds in the central warning the beginning of the crisis and, in turn mark the event in the EEG. In this way you can accurately determine the clinical and electrical start of the crisis.The rooms are individual, comfortable and safe for the patient. The basic and fundamental element of the monitoring unit is safety. At the time of the crisis is immediate patient care, avoiding possible injuries. The rooms are equipped with oxygen to help a speedy recovery and the beds have adequate protections.

Central of Rereading

The Central of Rereading for doctors and technicians is very important because it is where they review, discuss and study reports. The studies recorded can be seen repeatedly, changing working conditions, enabling better results.

The Recording System

The EEG recording system is performed in a computerized digital format that facilitates acquisition and data review. The study is reviewed in different assemblies, both referential and bipolar, you can change the filters, time constants and add electrocardiographic and respiratory aids. It also allows easy access to any part of the study for review. To register with surface electrodes it requires at least 16 electrodes, in our unit we use a minimum of 20 channels, adding ancillary where they are needed. An automatic detector program of events and pins can be used, in our case the form of event detection is more traditional and is through technicians and physicians that mark events that occur as the study is done. Our unit has split system log-Screen, where the monitor screen is divided into two parts, one where the image of the patient is and in the other the EEG record. This system allows you to see the clinical and EEG behaviors simultaneously and is very useful from a clinical point of view and teaching. This method is the most widely used in the reference centers for the study of epilepsy.

Patient Admission

A medical history of the patient is done where the monitoring program is carried out and the possible duration of the same is planned, which is not fixed, but depends on each particular case and the number of crisis that needs to be registered. The monitoring unit is ready to register for 5 days in a row in case the desired results are not obtained, the patient is asked to return for a second stage of monitoring, as many days as needed. When the patient arrives at the unit receives the second questionnaire on the frequency of crisis, kind, and the precipitating factors of the attacks. This is very important, because depending on the examination and diagnostic hypothesis, the assembly used is chosen and if the use of some additional parameter is required.

 

The Staff

Our unit has neurologists, Dr. Ignacio Pita and Dr. Horacio Daubon, and several highly trained technicians. In the central a technician is always present for patient’s care . All staff working in the unit is trained in the management of patients with epilepsy, it is essential the work of the technicians regarding the proper placement of the electrodes and operation throughout the study thereof the success or failure of the study may depend on this. Each member of the team interacts with the patient during a crisis and interprets EEG variables and other parameters that can get to use.Then doctors and technicians review the study in the rereading central.

Cooperation in set of medical, technical and relatives of patients is vital to the success of monitoring.

Indications of  EEG Video

The reasons why you can request an EEG monitoring can be:

  • Patients candidates for epilepsy surgery
  • Patients with refractory epilepsy
  • Patients with questionable or difficult diagnosis
  • Differentiating seizures, from non seizures
  • Quantify the number and type of crisis
  • Sleep disorders. (PSG)