Rationale:
Epilepsy Monitoring Units (EMU) are specialized inpatient facilities designed to evaluate, diagnose and manage patients with seizures, unclassified spells and epilepsy. EMUs provide an ideal space for long-term video-EEG monitoring with specially trained staff and constant observation allowing for the use of activating procedures and antiseizure medication withdrawal. Safety protocols are also in place for the management of prolonged seizures, postictal complications and status epilepticus. While EMUs are commonly available in urban centers, South Dakota opened its first EMU in January 2024. Prior to this, patients were referred to tertiary care centers in neighboring states, often requiring travel of several hundred miles. The goal of this study was to evaluate the clinical outcomes and benefits for rural patients during the first year of operation of South Dakota’s first EMU.
Methods:
A retrospective analysis was conducted on patients admitted to the adult EMU at Sanford USD Medical Center from January 1 and December 31, 2024. Data collected included patient demographics, travel distance, reason for admission, adverse events during admission, and study outcomes.
Results:
A total of 46 video-EEG studies were performed during the study period. Due to staffing constraints, two adult EMU rooms were available every other week, as the institution had only one epilepsy specialist. The majority of patients were white; with Hispanic and Native American being the most represented minorities, each representing 6.52% of the cohort. A total of 56.52% of patients were classified as rural. The median length of stay was 89.64 hours, and 78.26% of studies yielded a conclusive diagnosis. Half of the patients were covered by either Medicare or Medicaid. The median round-trip travel distance saved by patients was 339 miles.
Conclusions:
The establishment of an EMU in South Dakota has significantly enhanced access to epilepsy care for rural patients. The unit demonstrated a high diagnostic yield and a strong safety profile. Importantly, it reduced patient travel burden, allowing individuals to remain closer to home during extended hospitalizations. This represents a critical advancement in improving healthcare equity and quality for underserved populations.
Funding: None.