Evaluating Your Child's Condition

UH Rainbow Babies & Children’s Hospital Offers Leading-Edge Surgical Treatment for Children with Epilepsy

The Epilepsy Center at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, Ohio, has been accredited by the National Association of Epilepsy Centers as a Level IV center, offering nationally recognized, leading-edge treatments to children of all ages with epilepsy.

When seizures cannot be controlled by medication or diet, the experts at UH Rainbow Babies and Children’s Hospital offer innovative surgical treatment options for a variety of seizure disorders. These options result in treatment that is tailored and individualized for each child to give the best chance at curing seizures.

State-of-the-Art Testing Conducted by Multidisciplinary Team

The goal of the surgical evaluation process is to localize the area of seizure onset. Once the area of onset is located, it can be determined if the area can be safely removed. Localizing the area of seizure onset cannot be done with a single diagnostic test. Multiple tests help to map out and define the specific region likely to be responsible for generating the seizures. Testing is done by a multidisciplinary team that works together to produce the best outcomes, and consists of:

• Pediatric epileptologists
• Neurosurgeons
• Neuropsychologists
• Neuroradiologists

Evaluation, Testing and Treatment

If a child has seizures that are not controlled by anti-seizure medication or diet, we encourage parents to contact the experts at the Pediatric Epilepsy Center at UH Rainbow Babies & Children’s Hospital for further evaluation. The evaluation process involves several well-defined steps using modern technology to generate accurate maps of the electrical brain activity and images of the brain structures involved in producing seizures.

Step 1: Consultation with Epileptologist

The child’s evaluation starts with a consultation with a UH Rainbow Babies & Children’s Hospitals pediatric epileptologists at one of the many hospital or health center locations throughout northeast Ohio. During this visit, the epileptologist will make a first diagnosis based on the patient’s history of symptoms, the physical examination and interpretation of other tests that are available.

Step 2: Initial Testing

Additional testing will be recommended and discussed with the child’s parents and may include:

• Video electroencephalogram (EEG) recording for three to five days at the UH Rainbow Babies & Children’s Hospital Epilepsy Monitoring Unit
• High-resolution magnetic resonance imaging (MRI) of the brain (3T)
• Positron emission tomography (PET) scan
• Single-photon emission computed tomography (SPECT) scan
• Electric source localization (ESI) and magnet encephalography (MEG)
• Neuropsychological testing and evaluation

Video EEG recording is a continuous recording of the brain’s electrical activity that includes visualization of the patient’s seizure activity while the electrical discharge is spreading over the brain surface. This allows us to see what is happening clinically when there are abnormal electrical discharges occurring in the brain and may point to a potential surgical cure for a child’s seizures.

The high-resolution 3Tesla MRI allows us to identify structural abnormalities that may be causing the seizure activity. Electrical source imaging (ESI), MEG, PET scan and SPECT scans tell us more about the seizure focus using different modern technologies that measure blood flow and energy use in the brain.

Neuropsychological testing is done by expert psychologists to better understand changes in memory, language, attention span and behavior, which can have an impact on school performance and may need specific medical and educational management.

Step 3: Further Testing Using Electrodes

If these results point to a region of the brain that is producing seizures, we may move forward with more invasive testing which may involve placing electrodes into or onto the brain. These are called depth electrodes or subdural grid electrodes. This evaluation will follow once the epileptologist has discuss the recommendations from an interdisciplinary patient management conference. A team consisting of the neurosurgeons and other epilepsy expert will make these recommendations for further testing based on risks and benefits.

Step 4: Surgical Intervention

Multiple surgical options are available and dependent many factors that were established during the first steps of testing. Among the surgical options are:

• Cerebral hemispherectomy
• Corpus callosotomy
• Depth electrode monitoring
• Disconnection procedures
• Extratemporal, multilobar and hemispheric resections
• Lesionectomy
• Subdural strip and grid monitoring
• Subpial transections
• Temporal lobectomy
• Vagus nerve stimulators