Diagnosis & Treatment
How We Diagnose Epilepsy
When you bring your child to NewYork-Presbyterian, you benefit from a team approach that starts during your very first visit, when we begin assembling a plan of care. Tailored to each child’s unique clinical case genetic evaluation, we use advanced neuroimaging and long term EEG monitoring in our epilepsy monitoring unit (EMU) to capture and characterize seizures. Our specially trained neuropsychologists may also evaluate your child to assess how their seizures are effecting their thinking, learning, and attention as part of the comprehensive epilepsy assessment.
Your child may have one or more of these tests:
Electroencephalography (EEG or "brain wave test")
Electroencephalography (EEG) is an examination of a person’s spontaneous brain activity. We also offer outpatient EEG testing, which varies in length from about 30 minutes to 1-3 days if indicated and enabling your child to be mobile and go about his or her day while the testing is being performed over a period of up to 24 hours. Our trained EEG technologists and staff will guide you in how to prepare your child for the study and make the procedure less stressful for you and your child.
Video electroencephalography (EEG) monitoring
We use video electroencephalography to diagnose complex seizure disorders. The procedure requires the child to stay in the hospital for four or more days in one of our epilepsy monitoring units. Brain waves are recorded between and during a seizure to help the treating team understand where seizures begin and verify the true burden or number of seizures child may be having. Video recorded during events are used to better understand if the episode is in fact a seizure and, if so, provide additional information about where the seizure may be starting in the brain. For many children with subtle or hard-to-recognize seizures this may be the only way to confirm their seizures are well-controlled.
Intracranial monitoring/Stereo EEG monitoring
Intracranial (invasive) monitoring is used if a doctor decides your child may benefit from epilepsy surgery, but it is not immediately clear exactly where in the brain the seizures are coming from. It is also used if additional information is needed to ensure that surgery to remove the area of brain causing seizures will not result in new injury. Intracranial monitoring may involve the placement of electrodes onto the brain through a larger operation (subdural monitoring) or placement of separate wire-like electrodes into the brain through small (2 millimeter) holes in the skull (stereo-EEG monitoring), depending on the specifics of your child’s epilepsy. Stereo-EEG has changed how we approach many people with complex epilepsy, making it easier to study deep areas of the brain and, when necessary, both sides of the brain. In addition, stereo-EEG is better tolerated then subdural monitoring.
For many patients, special language and motor testing with the help of our epilepsy neuropsychologists is done during the intracranial monitoring. In some cases this is done with older cooperative patients awake in the operating room. For other patients similar evaluations are done in the EMU after we have completed recording of seizures activity but before the wires are removed.
Treatments We Offer
With the information we gather during your child’s evaluation, our epileptologists (doctors with special training in epilepsy care), neurologists, neurosurgeons, neurophysiologists, neuropsychologists, psychiatrists, and neuroradiologists work together to customize your child’s treatment. Your child’s treatment may include:
- Antiseizure medications. These drugs are effective in about two-thirds of children with epilepsy. We'll try a variety of medications to see if we can find one that works well for your child.
- Investigational therapies. Your child may be eligible to participate in a clinical trial of a new epilepsy treatment. Our researchers have played a significant role in the development and assessment of most of the new antiseizure mediations available today. We continue to conduct clinical trials of new epilepsy drugs.
Some children with epilepsy benefit from dietary changes that can reduce the frequency of their seizures. We offer nutritional guidance for epilepsy, such as how to follow a high-protein and high-fat ketogenic diet, a low glycemic index diet, or a modified Atkins diet. Our registered dietitian can teach you how to incorporate new dietary changes into your child’s life.
Vagus Nerve Stimulation (VNS)
We use VNS for some children and adults with epilepsy whose seizures are not well controlled with medication. We have the most experience in the mid-Atlantic region with VNS—a small pacemaker-like device implanted under the skin in the chest which sends small electrical impulses to the left vagus nerve to control seizures.
The goal of epilepsy surgery is to reduce or eliminate seizures in children whose condition is not well controlled with medication. Because of advances in brain imaging, we can now recognize subtle structural brain abnormalities that cause epilepsy. As a result, certain children and adults are now candidates for epilepsy surgery who may not have been considered for this treatment in the past. In some cases, surgery can actually cure epilepsy. In other cases, surgery may reduce the frequency and severity of seizures. Since uncontrolled seizures can lead to irreversible effects on cognitive and functional development, and in some cases be life threatening, surgery for epilepsy can be life-saving.
If your child is a candidate for epilepsy surgery, the team will first locate the source of the seizures to determine the type of surgery that will offer the best chance for a cure. This involves finding the exact source of the seizure activity, a process that includes high resolution MRI brain imaging, EEG tests, video-EEG monitoring, and the epilepsy team’s comprehensive evaluation of the patient. Some patients may also undergo intracranial monitoring to determine the exact source of the seizure activity.
Minimally Invasive Epilepsy Surgery
For children with clearly localized seizure sites (foci) that may be difficult or risky to access with traditional surgery, we offer several minimally invasive techniques, laser interstitial thermal therapy (LITT), also known as laser ablation, and stereotactic radiosurgery (SRS). Using computer-guided navigation, both of these techniques allow the surgeon to attempt to eliminate the seizure focus without making a large opening in the skull. Aided by MRI, the surgeon guides a laser through a three-millimeter incision and into the focus of a seizure to destroy the brain tissue causing seizures. Most children are able to go home the next day.
Traditional Epilepsy Surgery
For many children with epilepsy, their best chance of becoming free of seizures is to identify and remove the area of the brain where their seizures are arising. Our surgeons perform these surgeries with great success and have pioneered new techniques. We use brain mapping before and during surgery to carefully define regions of the brain near the area being considered for surgery. We may interrupt nerve fibers on the surface of the brain that carries the signals causing epilepsy symptoms or remove the specific area of the brain that is triggering seizures.
Innovative Approaches to Pediatric Hemispherectomy for Catastrophic Epilepsy
In the past, surgical treatment for children with catastrophic (medically refractory, severe and disabling seizures) epilepsy was considered only after a long period of seizures and multiple medication trials. Today, children who will develop catastrophic epilepsy can be identified earlier. For instance, we know that certain conditions of infancy lend themselves to this procedure, such as perinatal stroke; Sturge-Weber Syndrome; hemimegalencephaly, a rare neurological condition in which one side of the brain is abnormally larger than the other, and Rasmussen’s Encephalitis.
At NewYork-Pesbyterian, pediatric neurosurgeons are developing innovative approaches to pediatric hemispherectomies, a broad category of surgical resection and disconnection procedures that are performed to treat children with catastrophic epilepsy that often arise from a single hemisphere of the brain and can result in severe impairment.
Pediatric hemispherectomies are performed in children as young as one or two years of age or even in infancy. The ideal age for this procedure depends on the child’s overall health and the severity of his or her epilepsy.
Subspecialty Clinics and Programs
At NewYork-Presbyterian, we offer multiple subspecialty clinics and programs that provide expertise in all areas of epilepsy, particularly in treating early onset epilepsy and refractory epilepsy. These include:
- New onset seizure clinic
- Infantile spasms clinic
- Epilepsy surgery and neurostimulation
- Lennox Gastaut and other epilepsy syndromes
- Ketogenic Diet Program
- Genetics epilepsy Clinics
- Tuberous sclerosis complex
- Dravet syndrome/PCDH19
- Multidisciplinary Joint Neurosurgery-Epilepsy Clinic
Call for an Appointment
NewYork-Presbyterian Morgan Stanley Children’s Hospital
NewYork-Presbyterian Komansky Children’s Hospital
NYP/Weill Cornell Epilepsy Center
Columbia Comprehensive Epilepsy Center
Columbia Neurosurgeons - Department of Neurosurgery
NewYork-Presbyterian/Columbia - Department of Neurology
Weill Cornell Brain and Spine Center - Department of Neurosurgery
NewYork-Presbyterian/Weill Cornell - Department of Neurology