Treating Seizures in Children: Pediatric Epilepsy Program Video

Treating Seizures in Children: Pediatric Epilepsy Program Video

Brenda Banwell, MD: Pediatric epilepsy is a complex neurological disorder that affects 1 to 2 percent of children worldwide. At the Children's Hospital of Philadelphia, we have implemented a comprehensive, international, collaborative program to children with epilepsy around the country and around the world.

Dennis J. Diugos, MD: The goal of our Epilepsy Outreach Program is to provide a comprehensive, personalized assessment of the patient's medical history, seizure types, the cause of their epilepsy, and their treatment options, including epilepsy surgery for some patients. For international patients, these assessments can sometimes be facilitated via telemedicine.

Nicholas Abend, MD: Our partnerships begin with on-the-ground collaboration with local providers. We work with them to develop pathways at their institutions and appropriate links to CHOP, when necessary. This can involve collaboration and training of neurologists, pediatricians, EEG technologists, nurses, social workers, and psychologists. This is natural for us since CHOP is already a teaching hospital with many affiliate relationships. Therefore, we have long-standing expertise, working with collaborators and teaching.

Brenda Banwell: We begin with a 30- to 60-minute EEG recording performed at home and transferred to CHOP for interpretation. For many children, longer EEG recordings are required, particularly for infants or for critically ill children who may be having seizures that aren't recognized at the bedside. Via continuous 24/7 EEG recording, CHOP epilepsy specialists can help bedside clinicians manage acute seizures, can quantify and identify how many seizures a child is having, and can identify children who may be candidates for epilepsy surgery.

Dennis J. Diugos: Taking a careful medical and family history, sometimes through telemedicine for international patients, can also help us identify if there are genetic studies that can be conducted to help us better understand the patient and their epilepsy type. Children's Hospital of Philadelphia has invested heavily in our Epilepsy Genetics and Translational Therapeutics Program. New advances have led to the identification of specific genes that cause seizures, allowing us to more effectively target therapies, providing truly personalized epilepsy care.

Nicholas Abend: After a comprehensive evaluation, many patients will benefit from a personalized management plan, using both anti-seizure medications and other therapeutic strategies. This plan can be managed with in-person follow-up with the CHOP neurology team or via telemedicine approaches, thereby saving the family travel time and money. Other children may benefit from epilepsy surgery. These children would come to CHOP for a formal and detailed epilepsy surgery evaluation, in order to determine whether all of the seizures are coming from a resectable location.

Brenda Banwell: The Children's Hospital of Philadelphia has a large multidisciplinary epilepsy care team and a state-of-the-art facility. As a nationally accredited Level Four Pediatric Epilepsy Facility, the Children's Hospital of Philadelphia has the expertise to provide the highest quality medical and surgical care for children with epilepsy. In addition to managing seizures, it is also important to consider the impact of epilepsy on the life of a child. Our psychologists and social workers offer families and children support as they learn to live with epilepsy.

Dennis J. Diugos: The CHOP Epilepsy Program also includes a strong research component. Our scientists are dedicated to finding better explanations for why seizures develop, better treatments for seizures, and ways to prevent seizures from starting in the first place. Overall, we aim to bring advances from the laboratory to the clinic in the hospital, to improve patient care.

Nicholas Abend: When a patient arrives, they receive a hands-on, comprehensive and interdisciplinary epilepsy evaluation. This often involves routine EEG, ambulatory EEG monitoring, or admission to our Epilepsy Monitoring Unit. Sometimes, this also involves epilepsy surgery approaches, including stereotactic EEG.

Benjamin Kennedy, MD:  With stereo EEG, we implant electrodes into the brain without having to remove the skull. We can more precisely identify where seizures originate, and it also helps to identify areas that must be preserved, including those responsible for language, motor, and sensory function. Compared to older techniques, like craniotomy, this procedure is more minimally invasive, so this leads to a lower complication profile, as well as less post-operative pain.

Robotic assistance during the electrode placement is the most accurate technique available and can cut surgical time in half. Stereo EEG is a diagnostic tool, but here at CHOP, we're also using minimally invasive surgical techniques to treat a variety of epilepsy syndromes, including atonic drop attacks, gelastic seizures from hypothalamic hamartomas, as well as seizures from holohemispheric onset.

Phillip "Jay" Storm, MD: Surgery's an important option for children with epilepsy. If it’s determined that they're a surgical candidates, they should come to CHOP because we offer the most advanced techniques and highly innovative procedures. We're experts in many new epilepsy techniques, including laser ablation, robotically implanted stereo EEG, as well as cortical neuro stimulation.

These less-invasive procedures offer many improvements, such as decreased ICU stay, decreased infection, improved outcomes, thereby increasing the opportunity for patients with epilepsy to undergo surgery.

Brenda Banwell: At the Children's Hospital of Philadelphia, our Epilepsy Program is a resource for patients, families, and clinicians worldwide, partnering with physicians, sharing assets, and providing the best care for children with epilepsy.