Comprehensive Epilespy Center
Rady Children’s Comprehensive Epilepsy Center is accredited by the National Association of Epilepsy Centers as a Level 4 Epilepsy Center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.
Our specialized team consists of pediatric epileptologists, neurosurgeons, neuroradiologists, neurodiagnostic technologists, nurses and neuropsychologists. Meet our team.
Our EEG laboratory has been ABRET accredited since 2014 and performs outpatient and routine EEGs, ambulatory EEGs and outpatient video EEGs.
For selected patients who are judged to benefit from more detailed evaluation, inpatient video EEG monitoring is performed in a specialized unit of the Hospital. Mobile video EEG monitoring stations are used in an area where nursing staff is trained to evaluate patients with seizures according to specified protocols, assuring patient safety and proper assessment during seizure events. Video EEG data is accessible to clinicians through the hospital computer network. The goal is to record seizures and attempt to identify a location of seizure onset. This is the first step in evaluating a child for potential epilepsy surgery. Video EEG monitoring is also used to show non-epileptic events and characterize seizure types/epilepsy syndromes to guide further treatment options.
Epilespy has many treatment options, and our physicians work with families to design and individualize a treatment plan for each child. Anti-seizure medications are the primary treatments; other options are available depending on the cause of the seizures and/or failure to reduce seizures with two or more anti-seizure medications. These include:
- Ketogenic diet/modified Atkins diet/low glycemic index diet.
- Vagal nerve stimulator therapy (an implanted electrical neural stimulation device).
- Surgery (curative resective or palliative disconnection surgery).
Surgical evaluation includes:
- Epilepsy specialist evaluation and treatment.
- Video EEG monitoring.
- Neuropsychological testing.
- Imaging studies performed at Rady Children’s or outpatient UC San Diego facilities:
- 5T MRI: An MRI uses magnetic fields to create an image of the brain in order to determine structural abnormalities.
- Functional MRI: Measures the changes that take place in the active section of the brain. The patient is asked to perform certain tasks then the correlated area of the brain is studied to identify language, motor and visual areas for surgical planning.
- 3T MRI: 3 Tesla refers to the strength of the magnetic field. This scan creates the same three-dimensional images as the standard MRI. 3T MRI also picks up more signals from tissues and may result in clearer, sharper images.
- Magnetoencephalography (MEG/MSI): Records the magnetic component of brain waves and shows them on MRI images to identify areas of the brain that generate abnormal electrical activity that may lead to seizures. Areas of important function such as language and motor areas can be identified for surgical planning.
- PET: Shows how different areas of the brain use glucose and oxygen, which can be particularly helpful to identify areas of poor function that may indicate the area generating seizures.
- SPECT (available in 2016): Measures blood flow through the various areas of the brain during a seizure, which may be helpful in identifying the area of seizure origin.
Upon completion of all recommended studies, the findings are discussed at our multidisciplinary conference. If the team decides the child is a good surgical candidate, an individualized surgical plan will be developed. This may include:
- One-stage procedure, which may include electrocorticography at the time of surgery followed by surgical resection of the area of seizure origin.
- Two-stage procedure: In the first stage, electrodes are placed on the surface of the brain or into the brain tissue in order to record seizures and identify vital areas for speech, motor function and vision. The second stage includes returning to the operating room for surgical resection of the area of seizure origin.
Surgery may utilize a new robotic device called ROSA, which has been designed to increase the safety and reliability of neurological procedures. The robot serves as a surgical assistant, acting as a “GPS navigator” for the brain. Read more about ROSA.
Family Support and Education
To provide our patients and families with ongoing support and education, the program partners with the San Diego affiliate of the Epilepsy Foundation of America, which offers expressive arts therapy, parent support groups and family education seminars.
Epilepsy is one of the most common neurological conditions affecting children. The disorder, which causes recurrent seizures, can take many forms and has various causes.
There are 150,000 new cases of epilepsy each year in the United States, and children and the elderly are most at risk for developing the condition.
While significant progress has been made in treating some types of epilepsy, much remains to be done to improve quality of life for people with difficult-to-treat or drug-resistant epilepsy. For children and adolescents, the disorder often causes difficulties in school, uncertainties about social situations and other challenges.
In many people with epilepsy, no cause can be identified. Medical conditions that can lead to epilepsy include:
- Abnormalities of brain development.
- Traumatic brain injury/head trauma.
- Sequela of infections of the brain such as meningitis/encephalitis.
- Genetic conditions.