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Epilepsy

The Specialty Care Center for Adolescents and Teens with Epilepsy

The Specialty Care Center for Adolescents and Teens with Epilepsy provides care for patients who have recurrent seizures that have not responded to treatment with medications. These seizures can cause measurable disability, including limitations participating in school and related activities, recurrent injuries, and loss of confidence in social situations. Seizures can temporarily remove a person's ability to react in a potentially dangerous situation -- crossing the street, driving a car, playing a contact sport.

The field of epilepsy has pediatric epileptologists who address neonatal seizures, seizures soon after birth, and those in early childhood. These epilepsies are commonly associated with more complicated medical conditions such as metabolic disorders or developmental brain abnormalities. The adult epilepsy community is primarily treating patients in their late 20s and 30s who had late childhood/adolescent onset epilepsies. In fact, many of our adult patients with epilepsy developed the disorder as children but were not treated effectively. Evidence now suggests that if a second medication does not completely control the seizures, there is a less than 10 percent chance that any drug ever will, prompting the professional epilepsy community to offer other treatment alternatives earlier in the treatment process. The Specialty Care Center for Adolescents and Teens with Epilepsy does just this, focusing on early intervention for teenagers whose first or second medication therapy has not provided relief.

The Center ensures that adolescents have access to definitive diagnostic testing, receive appropriate medical attention, are offered information on alternative treatments that can control their seizures, and ample opportunity for discussion with a team of epilepsy specialists who can clearly explain the potential for surgical cure based on the origin of the seizures and facilitate the decision-making process with their families about treatment. Services include:

• a review of the current treatment and outcomes
• state-of-the-art diagnostic tests
• development of an alternative treatment plan that is reviewed throughout puberty
• discussion of surgical treatment options
• tools and support programs for teens and their parents to help promote communication and ongoing management of care

Diagnosis
The Specialty Care Center for Adolescents and Teens with Epilepsy recommends that parents of young adolescents and teenagers with a seizure disorder who have not had success with their first or second medication seek further evaluation of their child's condition. The Center offers a full complement of advanced procedures for diagnosis and seizure classification in order to develop a definitive diagnosis and a treatment plan to maximize control of the seizures.

The Center's Inpatient Epilepsy Monitoring Unit at Morgan Stanley Children's Hospital is a six-bed unit that combines video and EEG monitoring to determine the patient's epilepsy type, as well as the number and location of seizures. Video EEG-monitoring can either confirm or rule out a diagnosis of epilepsy and indicate who is a candidate for an alternative treatment to medicines, including epilepsy surgery.

Video and EEG readings are continuously recorded, digitized and stored electronically. This type of monitoring allows precise definition of seizure events in correlation with brain wave changes and provides key information about the location of the epileptic zone for potential surgical candidates. Monitoring results are supplemented by advanced structural and functional neuro imaging procedures, including routine MRI, PET scanning, SPECT, fMRI, and neuro psychological testing.

Treatment
Once it has been determined that two or three medications have not controlled the seizures, and video-EEG monitoring has excluded other diagnoses, neurosurgical intervention may be considered to remove brain tissue in the area that contains a seizure focus.

The epilepsy and functional neurosurgery program of Morgan Stanley Children's Hospital is one of the most active on the East Coast, involving close collaboration between pediatric neurosurgeons and pediatric neurologists to treat all types of seizure disorders. Our physicians use subdural grid electrodes implanted in the brain to identify the site of the seizures and map critical areas of the brain prior to epilepsy surgery. This enables the neurosurgeon to pinpoint which areas can safely be removed.