Undergoing Video Telemetry

What is video telemetry?

Videotelemetry (or VT) is the name given to a special investigation that involves recording a video of your child and monitoring their EEG (brain waves) during a seizure (fit). The EEG involves a number of leads being glued to your child’s head and these remain in place for up to five days during the admission.

Why does my child need one?

This recording will help us to get a better picture of where the seizures are coming from and what happens to your child when they have a seizure. The results can be used as part of a number of tests to see if your child is suitable for epilepsy surgery. The results can also be used to identify the area of the brain the seizures are originating from, or to see if the behaviours your child shows are epileptic in origin.

How long will my child be in hospital?

Your child will need to stay in hospital and will usually be admitted on a Sunday, as we would like to capture as many seizures as possible during your time with us. If your child has lots of seizures in the first few days it may be possible to go home sooner. This will be reviewed every day by the doctors and the Telemetry Technicians.

Where does this test take place?

The test takes place on Ward L52 in the telemetry room, which is a side room. There is an en-suite bathroom which has a shower and toilet in it. You will have to stay in or around the bed space as much as possible to make sure your child is on camera at all times.

Before your admission one of the Epilepsy Specialist Nurses will contact you to discuss your child’s seizures, medication and advise you about admission dates.

What do I need to do on the day of my child’s admission?

Please ring the ward on the morning of your admission to make sure that your bed is available and find out what time the ward staff would like you to come into hospital. If your child is admitted on a Sunday, then you will usually be expected to come in between 2pm-3pm. If your admission day is on any other day, we usually ask for you to come in the morning around 8.30am.

Information for when you are admitted to the ward

What happens during my admission?

When you arrive on the ward, your child will be shown to their bed. If your bed is not ready when you arrive you will be shown to the play room until it is. A nurse will go through all the paperwork needed for your admission. A doctor will also go through your details with you. If your child’s medication needs reducing to help bring on seizures this may start on the Sunday, though the EEG leads will not be put on until the Monday morning.

Does my child have to wear special clothing?

In the summer the ward can be very hot and we recommend wearing cool comfortable clothing. Children ideally should wear a onesie as they button up the front. For older children it is best to wear clothes that open at the front like a blouse or shirt or button through pyjamas. This is because they will have leads permanently attached to their head and two leads on both of their upper arms to monitor their heart (ECG) and other movements such as shaking. Your child does not have to wear night clothes through the day time but we do ask that you wear something as you are videoed both night and day. At night your child will be nursed without sheets in order to improve the video exposure.

What about my child’s medication?

Please bring all your child’s medications with you into hospital. Usually after admission children having a video telemetry are asked to reduce their antiepileptic medication in order to increase the chance of having a seizure. For some children who have lots of seizures whilst on their medication this may not be necessary. The medical team will make sure that you are aware of the plan for your child and it is important that you stick to this.

Due to this your child may have more seizures and/or more prolonged seizures than normal. We have to advise you that there is a risk of injury to your child as a result of increased seizures, but we will do everything we can to reduce the chance of injury e.g. padded cot sides on the bed. Their normal dose of medication is usually restarted before you leave hospital.

Monitoring – Your child will have their oxygen saturations and heart rate (vital signs) recorded while they are attached to the EEG leads. It is really important that the probe is attached at all times as the nurses will identify and record if the vital signs change before, during or after a seizure.

DO NOT reduce your child’s medication before you come into hospital unless directed to do so by your Consultant or the Epilepsy Specialist Nurse.

Will a nurse be with me at all times?

The nurses will check on you and your child hourly but will not be with you all the time. You will have a nurse call system that you can press if you need anything for your child or you need a nurse to come in to the room. You will be shown how to use this when your child is admitted to the ward. At night a clinical support worker will watch the video via the technician’s room on the ward opposite the Telemetry room.

Does my child have to stay in their bed/cot
all the time?

The EEG is connected to a long wire so if your child is mobile they will be able to move around the bed space; this will reach into the toilet (there is no video in the toilet). You can sit anywhere around the bed/cot area but we recommend your child is under the video camera at all times so that we can get an exact picture of what happens to them when they have a seizure.

We realise that keeping children under the camera can be difficult and the nurses and play staff will discuss activities that can be used to occupy them. It is better for the EEG team if your child stays in bed as much as possible, with the cot sides up for their safety, to optimise the video recording.

Does my child have to stay connected to the wires
all the time?

Yes, this is to make sure we capture as many seizures as possible.

Can my child have a shower or bath?

Once the EEG is on your child they will not be able to have a bath or shower as the steam from a bath or shower causes the EEG leads to become wet and can lead to them becoming disconnected. We recommend your child has a bed bath while staying with us.

Can I or my child use our mobile phone or iPads?

Unfortunately using some older mobile phones interfere with the EEG. This includes making calls and sending or receiving text messages so you may not be able to use a mobile phone during video telemetry. Your phone will be assessed during your admission to ensure it is ok to use. There is a phone available at your bed space, but this may be more expensive.

Your child can bring in their own iPad/tablet if they have one or you may borrow one from the ward during your child’s stay.

Can my child listen to music or watch television?

All beds on the children’s ward have a television above the bed known as Patient Line. This is free to use from 06:00 till 19:00 at night. The telemetry room also has a wall mounted TV which can play DVD’s.

Please make sure that the Patient Line TV does not obstruct the view from the overhead camera.

Is there anything else that I need to do?

You will be asked to keep an events diary for any seizures or unexplained feelings or absences that your child has during their admission. This helps to guide the Neurophysiologist reviewing your telemetry to focus on certain times as marked by you (although all the information is reviewed).

Video telemetry is REALLY boring; you will need to bring in things to entertain yourself as well as your child for the duration of the admission.

If you bring in anything electrical that needs plugging in please ensure that the plug has not been tampered with as this may fuse the ward and lead to danger for other patients.

Can I smoke?

Smoking is not allowed in the hospital as it is a non-smoking hospital. If you need a cigarette you must go to the outside designated smoking areas. Please tell a member of nursing staff if you are leaving your child so someone from the ward team can sit with your child. The use of electronic cigarettes are also not allowed in the hospital.

Anything else I need to know before admission?

Please be aware that colorants and perming lotion could interfere with the EEG recording so we do not recommend having your child’s hair permed or coloured in the week before your admission. Of course this will not apply to most children!

Other advice

• Your child will be monitored continuously for oxygen saturations and pulse. Please make sure that the saturation probe is on your child at all times, particular overnight as it is an important measure to ensure your child’s safety.
• Please do not allow your child to chew chewing gum whilst on video telemetry as this causes the muscles to move in the head and can mask a seizure on EEG.
• If you wish you may bring in your own pillow as some patients find the plastic covering on NHS pillows uncomfortable.
• Your child will receive all their food from the ward housekeepers, but I am afraid we do not provide food for parents. You may wish to bring snacks and food for your child and yourself. There is a microwave and fridge in the parent’s room which you may use. Please label your food.

If you have any questions or queries about video telemetry or your admission please do not hesitate to ring the Epilepsy Specialist Nurse on 0113 392 8121

Other information about Video Telemetry

Transport and parking

If you need transport to come into hospital please inform your GP. The ward can arrange transportation home if you have no-one who can pick you up. However we encourage wherever possible that you try to arrange your own travel home. There is parking at the hospital and if you live outside of Leeds you will be provided with a parking permit.

Medication

Before your child is discharged they will resume their usual antiepileptic medication dose, unless for some reason their Consultant would like to change your child’s dose of medication. You will be given a supply of medication to take home with your child, and a discharge letter which is also emailed to your GP so they are aware of the reason for your child’s admission.

General health

Although most children feel like their usual selves by the Monday after their video telemetry, some children continue to feel unwell for 1-2 weeks after. This is because the rapid withdrawal of medication and the increased number of seizures your child will have had, can cause their brain chemistry to be disturbed for a time. This may cause mood changes, increasing irritability and irrational behaviour. However, we will only discharge you if we think your child is safe to go home.

Hair care

You will be able to wash your child’s hair as soon as the EEG comes off on Friday (usually about 3pm). Sometimes people find that there are flakes of glue left from the EEG leads after the electrodes have been removed. The EEG technicians try to remove as much as possible but we advise you bring some conditioner and a narrow toothed comb which can be used to remove the leftover flakes. Once the hair has been washed we advise putting conditioner in the hair and combing the hair with the comb before rinsing. This will remove any flakes of glue and any bits of cotton wool used to remove the glue. You may need to do this more than once before all the bits are removed.

Results

You will get a general idea of the seizures captured for your child during your admission. As you can imagine it takes a long time to go through the data from around 100 hours of video telemetry so it can take up to three months for results to be formally reported on. This report will be sent to your Consultant who will see you and your child in clinic to discuss the results and what they mean for your child’s future treatment.

If we have not captured enough information for your child it may be necessary for further video telemetry in the future.

What next?

This depends upon your results of the video telemetry, and this will be discussed in your child’s next outpatient appointment