Pediatric Epilepsy Program
The Children’s Hospital of Georgia Epilepsy Program seeks to serve the needs of children with epilepsy and their families. For many children with epilepsy, seizures are completely controlled with drug therapy. For others, however, uncontrolled or poorly controlled seizures persist with the usual treatment. For these children, epilepsy presents a significant obstacle. Our aim is to help these children and families overcome this obstacle and to achieve their full potential.
If your child with epilepsy does not have satisfactory control of seizures, then our program may be able to help. Our goals are to reduce the number of seizures to the lowest level possible and to minimize the complications of treatment. Often, these goals can be achieved by a combination of various types of treatment, which is described below.
The following faculty and staff seek to help the children in this program:
- Dr. Yong Park, director of pediatric epilepsy, coordinates the activities of the program. Dr. Park has extensive training and experience in epilepsy. He is assisted by the other child neurologists in the group.
- Dr. James Carroll
- Dr. Patricia Hartlage
- Dr. Elizabeth Sekul
- Ms. Carmen Cook, child neurology nurse, assists with family education. Along with these professionals, other expert staff work with the child and parents.
No single treatment is suited to all patients with epilepsy. Therefore, we make available all of the methods useful in the treatment of seizures, including therapy with all medications presently available in the US, new experimental drugs, the ketogenic diet, vagal nerve stimulation, and epilepsy surgery.
Many new medications have been developed over the last few years for the treatment of epilepsy. These medications must be utilized in a methodical, careful manner, often requiring months to determine the best single drug or combination of drugs. The goal is to control seizures completely with a minimum of side effects. We have experience using all the approved medications for epilepsy.
We are also involved in ongoing trials utilizing newly developed drugs for epilepsy. Particular patients may meet the criteria for these new medications.
This dietary form of therapy has been known for most of this century, and its effectiveness has long been recognized. In the past 10-15 years, certain aspects of the diet have been improved and the importance of rigid adherence to the diet better understood. The diet can be extremely effective in children who have not responded to drugs and are not candidates for epilepsy surgery. Ms. Lisa Meyer, certified dietician, is well trained in the use of the diet and works closely with families who choose this form of therapy.
Vagal Nerve Stimulation
This method of treatment may also be useful for the treatment of patients who have poorly controlled seizures, which have not responded to medication. Although we do not understand why stimulation of the vagus nerve helps epilepsy, this method has proven effective in a number of children.
An electrode is surgically implanted around the vagus nerve in the neck during a minor surgical procedure. Our pediatric epilepsy surgeon, Dr. Mark Lee, does the procedure. A small box controlling the electrode in implanted under the skin of the chest and connected to the electrode. The electrode transmits an electrical current for stimulation of the nerve. The optimum treatment for the seizures is accomplished by adjusting the electrical characteristics of the stimulation. The period of adjustment may require eight to ten months to achieve the best results for the seizures.
Surgical Treatment for Epilepsy
When seizures do not adequately respond to the above measures, we help families consider the option of surgical therapy. In general, a child who is a candidate for surgical treatment of seizures usually has the seizures arising from one part of the brain. In order to determine if the child is a candidate for epilepsy surgery, he or she first undergoes a "Phase I" evaluation in our Pediatric Epilepsy Monitoring Unit (PEMU), which is under the direction of Dr. Yong Park. The PEMU is a two-bed unit where the child is connected to continuous EEG monitoring with video camera recording. The purpose of this procedure is to capture a seizure in progress and to determine the specific portion of the brain that is causing the seizure. A test called an ictal SPECT scan may also be performed along with an MRI to determine the exact area of the brain involved. Our neuropsychologist, Dr. Cohen, may administer tests to determine the impact of the epilepsy on learning abilities, according the specific area of the brain found to be affected.
If the "Phase I" evaluation is positive, but the results are not sufficient in order to plan surgery, a "Phase II" evaluation is performed. Here, Dr. Mark Lee surgically implants a grid for electrical monitoring over the surface of the brain. This is done to assess even more carefully the area of the brain involved.
After all the information is collected, the patient's problem is discussed at a joint conference among the physicians, neurosurgeon, and neuropsychologist. In this conference, the best possible surgical approach is developed.
After the recommendations are decided upon, the plan is presented to the family. We want to make certain that the patient and family fully understand the possible benefits and risks involved with the surgery.
Our goal is to reduce the number of seizures to the lowest level possible with a minimum of side effects. We understand the importance of family involvement in the choice of therapy.