Pediatric Epilepsy

At the UCSF Epilepsy Center, a pediatric epileptologist, two pediatric neurosurgeons, and a pediatric neuropsychologist provide specialized care for pediatric patients with epilepsy. To accurately diagnose and locate epileptic foci, the pediatric epilepsy team uses a combination of video electroencephalogram (EEG) recordings and 3T MRI scans for both structural and functional neuroimaging.  They may also use recordings from a magnetic encephalogram (MEG), which is similar to EEG but used a magnetic field to study brain waves. An MEG can be done in just 24 hours – a significant advantage over the weeks of hospitalization required for an EEG.

Approximately 15% of children with epilepsy have symptoms that cannot be controlled with medication.  Patients who do not respond after being treated with two different medications are assessed to determine whether or not they would be good surgical candidates. Patients are evaluated before surgery at a weekly conference attended by neurosurgeons, neurologists, and neuropsychologists.

 

During surgery, additional techniques such as electrocortiography and brain mapping are used to identify and avoid injury to sites of language, motor, and sensory function during surgery. A large number of surgical procedures are offered, such as hemispherectomy, corpus callosotomy, vagal stimulation, temporal lobectomy, extratemporal resection, and subpial resection.

 

UCSF is also currently offering a minimally invasive laser surgery called Visualase thermal ablation to eliminate seizure foci. With this new surgery, an MR-compatible laser fiber is guided toward the source of a patient's seizures. Then the laser heats and destroys the small, well-defined area of abnormal tissue, leaving the surrounding tissue unharmed. FAQ for Visualase Laser Thermal Ablation at UCSF



Mitchel Berger MD, Chairman of the Department of Neurological Surgery and a fellowship-trained pediatric neurosurgeon, is a pioneer of functional brain mapping in the surgical treatment of epilepsy related to brain tumors. Neurosurgeons Nalin Gupta MD, PhD and Kurtis Auguste MD also have fellowship training in pediatric neurological surgery and expertise in surgery for pediatric epilepsy. Joseph Sullivan MD, a neurologist with fellowship training in pediatric epilepsy from Children’s Hospital of Philadelphia, is also a member of the UCSF Epilepsy Center and specializes in treating refractory pediatric epilepsy.

 

Facts on Pediatric Epilepsy Surgery


· Fifty percent of pediatric patients who undergo surgery for epilepsy have their seizures controlled.

· If seizure foci are located in eloquent cortex, subdural grids can be used to map the foci during surgery to provide more detailed information about the location and increase the safety of surgery.

· Because younger children usually have a greater chance of functional recovery, an early referral for surgery is best.

· fMRI techniques are being incorporated into clinical use to provide a noninvasive method of localizing language and motor centers in the brain.