Neurology

Instructions for All Patients:

• Arrive 15 minutes early. Please allow 45 - 60 minutes extra time for parking/traffic.
• Patients should park in the new America Garage which is adjacent to the America Building (Bldg. 19).
• Do not bring children or siblings to scheduled appointment, unless specifically instructed to do so by your physician. The patient's appointment may be cancelled if children under the age of 12 are brought with no adult to supervise them.
• If the patient is going to be more than 15 minutes late for a scheduled appointment, the patient should contact the front desk with an estimated arrival time. If the department is notified of the late arrival, all attempts will be made to see the patient, but if more than 15 minutes late, the patient may need to reschedule the appointment.

Instructions for EMG Appointments

• Please wear loose fitting clothes so your muscles and nerves can be tested. Patient may be given hospital gown to wear.
• Please continue taking all medication prior to the test unless otherwise instructed by your physician.
• Please do not use lotions or creams on the areas to be tested.
• Notify the doctor doing the EMG if you have a pacemaker, or if you are taking blood thinners such as, Coumadin, aspirin, Aggrenox, or Plavix.
• Please do not smoke 3 hours before the test.

Preparing for your Video-EEG monitoring (EMU) Admission

Admission to hospital
On the day of admission to hospital please report to Walter Reed National Military Medical Center in the Eagle building 10 the first floor, Admitting Department around 0730 to check-in. If you are an Adult, you will be sent to the Epilepsy Monitoring Unit (EMU) on the 4th floor of the Eagle building 10 where you will stay for the monitoring session. If you are a Child/Adolescent you will be sent to the Epilepsy Monitoring Unit (EMU) on the 3rd floor of the Eagle building 10 where you will stay for the monitoring session. The EEG Laboratory on the 6th floor in the America building 19; is where you will have electrodes placed on your scalp for video-EEG monitoring. After the electrode placement you will go back to the EMU. (Please remember to come in with your hair free from any braids, weaves, spray, mousse, grease, or gel, just as you would for any EEG.)

A primary nurse will be assigned to you to plan all of your nursing care. The doctor or nurse will place a heparin lock (intravenous catheter) in a vein in your hand or arm. This is for your safety should you require any intravenous medication due to increased seizure activity. Visitors are welcome, and arrangements can be made for family members to stay with the patient.

Video-EEG monitoring tends to be quite boring, so please feel free to bring any books, needlework, cards, board games, or anything you enjoy doing that will help pass the time. The hospital offers free WiFi and each room is equipped with a telephone and television. Bring pajamas and comfortable clothing. Bring clothing that buttons down the front rather than clothing that goes over the head. Bring personal toilet articles such as a toothbrush, toothpaste, hand cream and etc. Please do not bring any valuables with you. The medical center cannot be responsible for money or valuables that are not stored in the medical center safe.

Also, please remember that this is a non-smoking institution. We may prescribe a nicotine patch if medically needed. Should you have any other questions about your stay here at Walter Reed National Military Medical Center, please do not hesitate to contact us at 301-295-4771 option 3 or 301-400-1862.

Some seizures, as you know, may cause injury. You need to be within the range of the camera as much as possible because we need to see your seizure activities. You cannot leave your room unless you are being sent for a special test such as an X-ray or scan. Depending on the severity and frequency of your seizures, you may need to stay in bed with the padded side rails up. In this case, you may need to have a nurse, aide, or other family member present for your bathroom trips or whenever you are out of bed. During the time you are being monitored, you will not be allowed to shower or wash your hair. You will be able to wash up from a basin in the bathroom or at your bedside. You will be able to shower and wash your hair after the monitoring is completed.

The length of your stay depends on the time needed to properly monitor your seizure activity. Although this varies among patients, a frequent length of stay is usually one week. We discuss your progress with you daily. Your doctor will meet with you to discuss your results after all the information has been reviewed. If were referred by another doctor, a formal report will be sent to him/her as soon as the information has been analyzed.

Instructions for EEG Appointments

• Patients receiving a sleep deprive EEG should have no more than 4 hours of sleep the night prior to the appointment. Patients may stay up late and sleep prior to the appointment, or they may go to sleep at the regular time and wake up after 4 hours of sleep.
• Please do not eat or drink foods that contain caffeine (such as coffee, tea, cola, and chocolate) for 24 hours prior to the test.
• Please continue taking all medication prior to the test unless otherwise instructed by your physician.
• Please be sure that your hair is clean and free of sprays, oils, creams, and lotions. Shampoo your hair and rinse with clear water the evening before or the morning of the test. Do not put any hair conditioner or oil on after shampooing. Patient's scalp needs to be free of hair pieces, not braids, weaves, or cornrow. There are no facilities available to wash your hair after the test.
• To find certain types of abnormal electrical activity in the brain, the patient needs to be sleepy during the recording of the test. The patient may be asked not to sleep at all the night before the test (These instructions will come from the referring physician).
• After this your hair will be dirty (residue/paste) left in your hair, and the department has limited facilities for washing your hair. Please come prepared with a hat/scarf to cover your hair after the appointment.

Instructions for Autonomic Appointments

• Wear loose fitting athletic clothing with easily removable shoes/socks. The test will take approximately 45 minutes.
• Do not eat or drink anything with caffeine (such as coffee, tea, cola, and chocolate), or smoke for 4 hours prior to the appointment.
• Some medications can interfere with the test. Patients should consult with the referring physician regarding their current medications.
• Do not take any over the counter cold or cough medications, antihistaimines, antidepressants or diuretics 48 hours prior to the test.
• No vigorous exercise for 24 hours prior.

Evoked Potential Appointments
This procedure checks the integrity of the peripheral nerve paths (nerves of the arms and legs). This procedure normally takes 1 hour per modality. 1 hour for both arms and 1 hour for both legs. This time applies to a cooperative patient with no extenuating circumstances. May also be termed "Somatosensory evoked potential", SSEP, MEDIANS, TIBIALS, UPPERS, or LOWERS.

The other type is Auditory Evoked Potential or Auditory Evoked Response. May also be termed : BAER’s,BAEP’s,AEP’s, BEP’s, AER’s. This procedure checks the auditory nerves of the ears. This procedure usually takes approximately 30 to 45 minutes. This time applies to a cooperative patient with no extenuating circumstances.

The last type is the Visual Evoked Potential or Visual Evoked response. May also be termed : VER, VEP. This procedure Checks the Optic Nerve paths. This procedure usually takes approximately 30 to 45 minutes. This time applies to a cooperative patient with no extenuating circumstances.

One VEP or one BAER may placed in an EEG slot but has to be clearly annotated as to which procedure it is.

Instructions

• Shower or Bathe and wash and dry your hair.
• Don’t use lotions, oils, powders or any hairstyling or hair products following your shower or bathe. Your hair should be clean,dry and free of any excess oil.
• Wear loose fitting clothes, but know that you may be asked to change into a hospital gown.
• Your testing may last from 30 minutes up to 4 hours. The test time depends on how many tests you’re having. Be sure to allow extra time to check in.
• Any questions about procedures or scheduling please contact one of the Technicians.

Ophthalmology Visual Field Exam
Instructions

• Patients are to wear or bring a current set of glasses or contacts with them to the appointment.