Inside Pediatrics Winter 2015

At the Forefront of Epilepsy

Inside the Red Line

epilepsy center for evaluation by an epileptologist,” said epilepologist Monisha Goyal, M.D., director of Children’s Pediatric Epilepsy Program. At Children’s, patients with epilepsy are evaluated and treated by a multidisciplinary team of epileptologists, pediatric neurosurgeons who specialize in epilepsy surgery, a neuropsychologist, specially trained epilepsy nurses, nurse practitioners, EEG technicians and child life specialists. The workup includes a detailed medical history, physical and neuropsychological examinations, blood tests and VEEG, which includes continuous closed-circuit video monitoring over several days in the hospital’s eight-bed epilepsy monitoring unit. Each patient also undergoes high-quality MRI, usually under sedation. Depending on the results of the preliminary testing, more localized studies, including PET scan and SISCOM may be performed. A functional MRI (fMRI) or Wada will also be performed to lateralize speech and movement. Patients may also undergo

for surgery. “We have a lot of new drugs, and many can be combined with tolerable side effects,” Blount said. “But one-third of the patients have few options available to them through medication. They have uncontrollable seizures that typically get worse over time and affect their quality of life.” Recent advances in imaging technology have given doctors a better understanding of how and where in the brain seizures occur. The knowledge opens the door for more surgical options. “Surgery offers a real and relatively low-risk intervention to deal with the epilepsy,” Blount said. “It used to be for the worst of the worst, but we’ve made inroads, and more and more kids are being referred for surgery.” The path to managing epilepsy often begins with the child’s primary care physician, but if prescribed medication fails to control seizures, a red flag is raised, signaling the need for more specialized care. “When two to three medications don’t work, the child needs to be referred to a specialized

Once thought to be a curse from the gods or evidence of possession by evil spirits, epilepsy has plagued those who suffer from this often baffling neurological disorder since ancient times. For centuries treatment was elusive, but today, neurologists and neurosurgeons at Children’s of Alabama are encouraged by the success they are having in reducing seizures in their patients and restoring a quality of life lacking for many. According to Children’s pediatric neurosurgeon Jeffrey Blount, M.D., epilepsy affects 50 million people worldwide. “It’s the second most common neurological affliction in children,” he said. “It’s devastating because it takes away the capability to plan and control your life because of the unpredictability and nature of the events.” Treatment options have increased and improved over the past several decades. Most children with epilepsy are successfully treated with medication, but a small number of those diagnosed with refractory epilepsy are often candidates

• Children’s recently became the first and only freestanding pediatric hospital in the U.S. and one of only five hospitals in the nation to earn accreditation for its epilepsy monitoring unit (EMU) from the American Board of Registration of Electroencephalographic Technologists (ABRET.) Accreditation is for five years. • The EMU is designated as a Level 4 unit by the National Association of Epilepsy Centers, the highest level attainable. A Level 4 center provides the more complex forms of intensive neurodiagnostics monitoring, as well as more extensive medical, neuropsychological, and psychosocial treatment. Fourth-level centers also offer a complete evaluation for epilepsy surgery, including intracranial electrodes, and provide a broad range of surgical procedures for epilepsy.

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