Neurology patients that would benefit from prolonged monitoring for the accurate diagnosis of conditions including epilepsy can now have their brain activity tracked at home, through Monash Health’s new Ambulatory EEG Service.
Until now, patients with complex epilepsy or infrequent neurological events have had to be admitted to Ward 54 at Monash Medical Centre for one to three days for prolonged Video Electroencephalogram Monitoring (VEM).
For some patients this has necessitated taking time off work and making alternative care arrangements for dependents. Some patients have instead opted to pay for private ambulatory services costing hundreds of dollars.
The advantages of prolonged monitoring in the home extend beyond patient comfort and convenience.
“Patients are more likely to have an event at home because they are not confined to a bed, they are doing their usual activities like walking around, brushing their teeth, going to the toilet,” said Clinical Lead Neurophysiology Scientist Giosi Cardamone.
Longer periods of monitoring provide a more comprehensive overview of a person’s brainwave activity.
“Prolonged monitoring is really useful where a patient is having possible neurological events but it has been difficult to capture that on a standard 25 to 30 minute recording. It might help us to diagnose or characterize exactly what those episodes are, and make sure that the patient gets the right treatment,” said Consultant Neurologist Subramanian Muthusamy.
In the Neurology Department at Monash Medical Centre, staff attach small metal discs called electrodes to the patient’s scalp.
The electrodes are connected to wires that lead to a small unit in a soft pouch that the patient wears.
A bandage helps keep the electrodes in place. The unit sends data wirelessly to a PC in a small portable case.
A video camera on a tripod attached to the case records what happens to the patient during an episode.
“Once set up at the clinic, the patient wheels [the kit] to their car and takes it home. Once they get home, they put the case in the corner of the room they are in and plug it in. They angle the camera to where they will be sitting or sleeping, and it starts recording. If they need to move rooms then they just repeat the process,” said Senior Neurophysiology Scientist Ivana Peric.
Currently the Ambulatory EEG Service monitors patients for up to 24 hours.
“The battery can last up to three days, so we can potentially go longer. But we have not done this remotely before and we must make sure all the [electrode] connections stay put and are working. In the future we may go longer,” said Ivana.
The new service will reduce the wait list for inpatient VEM.
The new kit can also be used on wards around Monash Health, with the Intensive Care Unit (ICU) among areas expected to make use of the resource.