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A Holistic Approach to Epilepsy in Children

NEW YORK (Jan 13, 2014)

When a person is diagnosed with epilepsy, it is life-changing news. When that person is a child – and many people with epilepsy do learn they have epilepsy in childhood – the diagnosis has ripple effects that go beyond the child's health. How will it affect his performance in school? How will she feel around her friends? How are sisters and brothers affected? Can both parents work, or does one need to stay closer to home?

Juliann M. Paolicchi, M.D.
Juliann M. Paolicchi, M.D.

At the Pediatric Comprehensive Epilepsy Program at NewYork-Presbyterian Phyllis and David Komansky Center for Children's Health at Weill Cornell Medical Center, a comprehensive and highly experienced team takes a holistic approach to every patient with epilepsy, providing treatment the child or adolescent as well as education and support for parents and other family members.

"The needs of a child with epilepsy affect the entire family," says Juliann M. Paolicchi, M.D., professor of clinical pediatrics at Weill Cornell Medical College and an authority on the care and study of pediatric epilepsy who directs the Pediatric Comprehensive Epilepsy Center. "We work closely with families to address the needs of each child and assess how those needs influence the family dynamic." The center also has staff available to help school-age children keep up with their education.

In epilepsy, the pattern of electrical activity in the brain is abnormal, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. According to the Epilepsy Foundation, about 326,000 children in America under age 15 have epilepsy, and 200,000 new cases of epilepsy are diagnosed each year. For some children, the problem is temporary, but for others it remains a lifelong challenge.

The care of a child with epilepsy begins with an accurate assessment of the source of seizures and what triggers them. The Komansky team uses sophisticated imaging tools, techniques to assess brain function – including EEG monitoring – and special "electrophysiologic" approaches to "map" the areas of the brain where seizures are starting and spreading.

Armed with the results of these tests, the team puts together a personalized plan of care for each patient, with the goal of controlling the seizures and enabling the child to live as normal a life as possible. "We tailor therapy to each patient's individual needs, taking into account other factors – such as lifestyle, stress, sleep habits, and diet – that may trigger their seizures," says Dr. Paolicchi. The healthcare team includes pediatric epileptologists (doctors with special training in the care of patients with epilepsy), neuropsychologists, neuroradiologists, neurosurgeons, nurse practitioners, and therapists. Patient care coordinators help families schedule the various clinical services that children may require at NewYork-Presbyterian Hospital.

The first line of treatment is typically antiseizure medication, which is effective in most patients. But in up to one-third patients, seizures continue despite medications, and for them, surgery may be an option. Having mapped areas of the brain where seizures are occurring, surgeons may interrupt nerve fibers that carry the impulses responsible for epilepsy symptoms, or they may remove the specific area of the brain generating seizures. All children who are possible surgical candidates are discussed at a conference composed of a team of epilepsy and neurosurgery specialists who review every aspect of the child's case, with the goal that patients will become seizure-free and without any further deficit.

Some children respond well to vagus nerve stimulation, in which a small pacemaker-like device is implanted under the skin in the chest to send small electrical impulses to the vagus nerve, reducing the number and severity of seizures. Patients whose seizures continue despite standard therapies may have the opportunity to participate in clinical trials.

Dr. Paolicchi notes that for other children, dietary changes may reduce or eliminate their seizures. There are several dietary options available in addition to the rigorous ketogenic diet, including the modified Atkins diet and the low glycemic index diet. Our specialized pediatric epilepsy nutritionist can meet with each family to determine the child's nutritional needs and whether diet, supplements, or vitamin therapies are indicated.

It's not unusual for children with epilepsy to have other neurologic problems, such as such as migraines or depression. For these patients, doctors try whenever possible to streamline therapy by using one medication to treat both conditions.

One of the strengths of the Pediatric Comprehensive Epilepsy Program is transitioning adolescents with epilepsy to adult care, providing referrals to the adult epilepsy program at NewYork-Presbyterian/Weill Cornell to ensure that treatment is uninterrupted. "Epilepsy is a lifelong condition, and patients' needs change as they get older, particularly when they are teenagers," concludes Dr. Paolicchi. "We work with teens to help them understand that they need to be responsible for their health as they get older. We also like to hear about their personal goals. We can then use this information to make sure their therapy is personalized to their needs at each stage of their lives."

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