Hospital News
Neurology
Specialty Centers
Pediatric Epilepsy Center
The Pediatric Epilepsy Center of Morgan Stanley Children's Hospital draws on the close collaboration between pediatric neurologists and pediatric neurosurgeons, as well as the resources of the adult neurology department of NewYork-Presbyterian/Columbia to treat all types of seizure disorders. It is one of the most active pediatric epilepsy programs on the East Coast and is a major referral program for the treatment of intractable seizures.
A disruption in the brain's electrical impulses, epilepsy is characterized by recurrent unprovoked seizures. Chronic epilepsy can have severe effects on the developing brain, and that is why surgical treatment in children may be recommended for children following careful evaluation.
Our neurologists utilize highly sophisticated diagnostic techniques, including video-electroencephalography (EEG) monitoring and biochemical and imaging modalities, to evaluate children with seizure disorders. Our technologists are particularly skilled in working with children to help alleviate anxieties connected with the procedures.
Our six-bed inpatient Pediatric Epilepsy Monitoring Unit, which serves nearly 400 patients a year, enables us to perform the testing necessary to confirm a diagnosis and determine appropriate medical management. Here patients are monitored by video-electroencephalography (EEG), with access to imaging studies that include high-resolution MRI, ictal single photon emission computed tomography (SPECT), and positron emission tomography (PET). These brain mapping studies enable us to identify the specific area of the brain involved in seizure onset. We also use neuropsychological testing to uncover possible memory and cognitive changes.
In all cases, therapy is tailored to the individual child, and treatment options may include the full range of anti-epileptic medications, the ketogenic diet and vagus nerve stimulation. Some children benefit from surgery, which is guided by sophisticated brain mapping techniques. Once the focus of the seizure is pinpointed, our neurosurgeons can safely remove the involved portion of the brain. Infants and children's brains are more plastic than an adult's. In other words, an injury or operation that might lead to significant dysfunction in a adult generally has a better outcome in children, where uninvolved areas of the brain have the capacity to take over some functions of the injured region.
We continue to explore new anti-epileptic medications, neural monitoring technologies, and implantable stimulation devices. In addition, an implantable miniaturized monitoring system that records the abnormal electrical activity of individual neurons involved in epilepsy is also under study.
The Specialty Care Center for Adolescents
and Teens with Epilepsy
The Specialty Care Center for Adolescents and Teens with Epilepsy, a component of the Columbia Comprehensive Epilepsy Center, is the only specialty care center for the treatment of adolescents and teens with epilepsy and seizure disorders. The average age of onset of epilepsy is 9 to 12. Children and teens with epilepsy have a unique set of circumstances. They are starting to develop their own identity, seeking to gain independence from their parents. This can be a particularly challenging stage for parents who have dedicated themselves to managing their child's care and now need to hand over the responsibility for medication compliance. Our staff are dedicated to helping teens and adolescents cope with epilepsy during a time when they are seeking independence, trying out adult decisions and behaviors, and learning about the changes in their body and how they will impact their medical issues.
The Specialty Care Center for Adolescents and Teens with Epilepsy, directed by world-renowned epileptologist Frank Gilliam, MD, MPH, 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
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.
TreatmentOnce 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.
Spasticity Center
The Spasticity Center at Morgan Stanley Children's Hospital is a multidisciplinary program that includes pediatric specialists in neurology, neurosurgery, orthopedic surgery, physical and occupational therapy. Spasticity results from damage to the motor pathways of the brain or spinal cord. It is characterized by stiff muscles and exaggerated reflexes that can interfere with gait, movement, or speech. Symptoms and signs may include scissoring or crossing of the legs, clonus (repetitive jerking of the ankles or other joints with minimal stimulation) and posturing of the limbs. Typically, the upper extremity is flexed and the lower extremity is extended. Chronic untreated spasticity can lead to muscle contractures.
Our healthcare team provides consultation and treatment services during a single visit, avoiding the need for multiple appointments over several months. Patients undergo a thorough examination to determine the optimum management plan for their particular condition. This may involve a combination of physical and occupational therapy (including positioning, bracing, splinting, and casting), Botox intramuscular injections, Baclofen and other oral medications or Baclofen pumps that are implanted under the skin to dispense medication directly into the spinal fluid. In some cases neurologic or orthopedic surgery is required for an optimal outcome.
Our Spasticity Center is the only program in the tri-state area and among the few nationwide that performs minimally invasive selective dorsal rhizotomy to relieve spasticity due to cerebral palsy. Traditionally this operation involved removing five levels of bone during an eight-hour surgery. Today, our surgeons remove just one level of bone through a minimally invasive approach. The operation is much quicker and children recover faster, allowing them to begin the process of retraining their relaxed muscles with physical therapy and rehabilitation at an earlier stage.
