Delaware Public Media

Christiana Care brings epilepsy monitoring unit to First State

Jul 27, 2018

Christiana Care Health System opened the state’s first epilepsy monitoring unit at its Christiana Hospital in Newark earlier this year.

And Delaware Public Media’s Nick Ciolino reports, it’s the only place in Delaware where doctors try to induce patients into having a seizure so they can make a diagnosis.


Alyssa Petriccione was born and raised in Newark.

 

She’s 24, engaged to be married and works in sales and customer service at a house cleaning service called Maid Pro.

 

She also plays in a local roller derby league.

 

A few hours ago she checked into the new Epilepsy Monitoring Unit at Christiana Hospital.

 

“I’m here to get study on pretty much what’s causing my seizures to get more answers to see where we can go from to here to kind of stop them from happening since they’ve been getting pretty bad lately," said Petriccione.

 

Alyssa began having seizures when she was very young but went years without one until she an episode in school at the age of 16.

 

Doctors started her on epilepsy medicine but last year it stopped being effective.

 

Now she is in a hospital gown sitting up in bed with her laptop. She’s hooked up to an IV, she has electrodes from an EEG attached to her head to measure electric activity in her brain and her heartbeat is monitored by an EKG.

 

Doctors are weaning her off her medication to try to induce a seizure so they can figure out which treatment will work best.

 

“I’ve been preparing myself for a while but it’s still a little nerve-racking a little nervous to deal with,”

Petriccione said.

 

The room is equipped with a special safety vest hooked to the ceiling. When Alyssa stands up, she has to put on the vest so that if she seizes she doesn’t fall to the ground.

 

Stabilization Vest in the EMU at Christiana Care
Credit Nicholas M Ciolino

 

She and one other EMU patient in the room next to hers are being video monitored 24-7 by a tech just outside, and a nurse is in and out to check up on the patients.

 

The nurse on duty today is Tony Gilley.

 

“It’s definitely the hardest on them. They struggle coming off of their medications and the feelings that go with that as well as a lot of them are afraid to seize. They’re afraid of what could come of that," said Gilley. "It’s a lot of emotional support that you’re there for the patients, I think, more than medical.”

 

Gilley says there are a variety of techniques she uses to try to help induce a seizure including photo simulation, sleep deprivation and exercise.

 

“We do biking trials with them where we have them bike for as long as they can tolerate, but usually it’s like 10 to 15 minutes. We also do walking trials with our walking vest. So we have them get in the walking vest and just do a few little laps around the room to try to induce episodes,” said Gilley.

 

When a patient seizes Gilley performs a cognitive test to see if the patient is awake while they are having the seizure.

 

She’s also ready with rescue medication to administer intravenously if a patient goes into a prolonged seizure.

 

Dr. John Pollard is the Medical Director of Epilepsy at Christiana Care.

 

He says the results from the cognitive test and the readings from the EEG and EKG determine what kind of seizure the patient had and which treatment will be administered.

 

“And based on that we can tell if that was an epileptic seizure or a non-epileptic seizure. We can tell whether that seizure is coming from the whole brain at once or one spot of the brain and we can tell if that patient might be eligible for a brain surgery to help stop these seizures altogether,” said Dr. Pollard.

 

The most common surgery for epilepsy is restrictive surgery, where the small part of the brain creating the electric activity that causes the seizures is removed.

Pollard says sometimes patients diagnosed with epilepsy in the EMU just need a different medication but that is less common.

 

He says about 40% of patients are suffering from non-epileptic seizures, or psychological seizures.

 

“So there may be a stress or a certain kind of thought that somebody has that almost inevitably leads to the non-epileptic seizure, which I should point out is not a voluntary response. No one would want to have something like that,” said Dr. Pollard.

And that is what doctors determined was the cause of Alyssa Petriccione’s seizures.

Alyssa spent five days in the EMU, which is about the average at Christiana Care.

“It went well for what it was. It was very frustrating to be in there for five days. You do go stir crazy,” said Petriccione.

But she was eventually able to seize, and doctors found her seizures were non-epileptic and most likely caused by stress.

Dr. Pollard says patients can often be cured of these type of seizures with cognitive behavioral therapy, and there is a specific program available at Christiana Care.

“So we can actually take those 40% of patients who we thought had drug-resistant epilepsy, change their diagnosis and get them treatment right here at Christiana Care,” said Dr. Pollard.

And Alyssa says she’s looking into therapy but is looking forward more to going back to practice with her roller derby team The Diamond State Roller Derby.