Two-year experience of a newly established epilepsy monitoring unit in a resource-limited setting.

Epilepsy Monitoring Units (EMUs) play a critical role in epilepsy management, yet they remain scarce in resource-limited settings. This study presents a 2-year experience of a newly implemented EMU in Mexico, evaluating its clinical impact, procedural metrics, and challenges. This retrospective study included 117 patients admitted to the EMU of a private hospital in central-western Mexico between February 2023 and December 2024. Patients underwent tailored protocols for long-term video-EEG monitoring for diagnostic clarification, treatment optimization, or presurgical evaluation. Diagnostic and therapeutic outcomes, seizure yield, and safety metrics were described. The EMU facilitated diagnostic changes in 59% of patients, with 80.3% undergoing treatment modifications. Among presurgical evaluation patients, 80.8% exhibited seizures during admission. Seventy-two percent of patients achieved a favorable seizure outcome at one-year follow-up. Twelve patients underwent epilepsy surgery, with resective procedures being the most common. Status epilepticus and seizure clusters, occurred in 2.5% and 0.8% of patients, respectively. The implementation of a high-quality EMU is achievable in resource-limited settings. : This study highlights the importance of tailored protocols and multidisciplinary collaboration, providing a practical framework enhancing epilepsy care and bridging gaps in epilepsy management in underserved regions.