Epilepsy is a neurological disorder characterized by recurrent seizures. It affects children at different ages and in different degrees, from mild and easy-to-control to a severe, lifelong problem.
The Comprehensive Pediatric Epilepsy Program at the University of Michigan C.S. Mott Children’s Hospital is recognized as by the National Association of Epilepsy Centers (NAEC) as a Level 4 Certified Epilepsy Center, the highest certification available from the NAEC. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest-level medical and surgical evaluation and treatments for patients with complex epilepsy.
Seizures are caused by abnormal bursts of electrical activity in the brain. They usually don't last very long, but they can be frightening for families.
Symptoms of epileptic seizures can vary, but the following may be signs that your child is experiencing seizures:
- Loss of consciousness
- Abrupt movements of the arms and lets
- Stiffening of the body
- Breathing disruption
- Falling for no apparent reason
- Not responding to sounds for brief periods
- Head nodding
- Periods of rapid blinking and staring
Seizures may cause problems with:
- Muscle control
- Speech and Language
- Memory and learning
The first step to managing pediatric epilepsy is accurate diagnosis. As part of your initial evaluation, our care team will perform a physical evaluation and obtain a complete medical history, including obtaining information about the seizures your child has experienced.
Diagnostic tests will help us formalize a diagnosis, often including:
- Blood tests, including routine labs and sometimes genetic or metabolic testing
- Electroencephalogram (EEG) to measure brain activity during a seizure or between seizures
- MRI, positron emission testing (PET scan), functional MRI, computerized tomography (CT scan) and/or single photon emission computed tomography (SPECT) to look for scar tissue or other brain abnormalities that may be causing seizures
- Lumbar puncture (spinal tap) if there is a chance of infection or to rule out other problems
Our state-of-the-art pediatric EEG lab provides EEG testing for infants, children and adolescents. For our outpatients, we offer routine EEG studies (usually lasting less than one hour), short-term (6-hour studies) and ambulatory EEG monitoring for pediatric patients.
In addition, we perform more than 650 inpatient EEG studies annually. Scheduled admissions for EEG monitoring are used for diagnosis (to decide if a child’s events are caused by seizures), seizure classification (to determine what kind of seizures a child is having), and for epilepsy surgery evaluations. We also perform EEG monitoring for children in our intensive care units who are suspected to be having seizures.
Because accurate diagnosis is a critical aspect of formulating an effective treatment plan for each individual child, we’ve built our epilepsy program to include consultation with associated pediatric professionals in a number of departments across the field of medicine, including genetics, metabolism, neurosurgery, developmental behavioral pediatrics, neuropsychology, psychiatry, psychology, nutrition services, and physical medicine and rehabilitation.
Our approach to caring for children with epilepsy is centered on controlling, decreasing frequency or eliminating seizures in a way that minimizes interference with a child’s growth and development.
The good news is that treatment is usually very effective for children with epilepsy.
Medication - About 70 percent of children with epilepsy can obtain control of their seizures with one medication. Treatment goals emphasize using the minimum amount of medication necessary to achieve satisfactory control, and monitoring status on an ongoing basis to minimize side effects. Our neurologists have extensive experience in administering the full spectrum of available medical therapies, ranging from traditional medical protocols to novel pharmacotherapies.
Diet – The ketogenic diet is a specialized diet that may be appropriate for certain children who do not respond well to standard medication therapies or have problems with medications. The diet is high in fat, and low in carbohydrates and protein. Our ketogenic diet team includes specialists in neurology, dietetics, behavioral feeding psychology, social work, pharmacy, nursing and our program coordinator. We also have a nurse practitioner with special expertise working with families adjusting to the ketogenic diet. Our multidisciplinary team meets monthly to review our protocols, plan for our newest patients’ care, and problem-solve any issues arising for our established patients. We also provide a number of peer support mechanisms including a private Facebook group for our keto families to share experiences and support one another.
Surgery – In some cases, surgery can either cure or significantly improve quality of life for children with continued, disabling seizures that do not respond to other therapies. Our renowned pediatric neurosurgical team has deep expertise with surgical techniques to help control seizures. Our pre-surgical evaluation focuses on the precise localization of a seizure to a specific focal area of the brain, and an assessment of the potential consequences of removal of that tissue on the child’s functioning. Surgery can be used to temporarily implant electrodes on or in the brain to precisely define the part of the brain causing seizures and to confirm what neurological functions that part of the brain performs. If it is determined that the part of the brain causing seizures is not responsible for critical neurological functions, surgical removal of this area is an option and can be highly successful in controlling a child’s seizures. When the part of the brain causing seizures cannot be removed without compromising critical brain functions, some patients are candidates for implantable stimulators that “pace” the brain to stop or reduce epileptic seizures.
C.S. Mott Children’s Hospital is the only children’s hospital in the state of Michigan offering an intraoperative MRI operating room for epilepsy surgery patients, which offers a higher level of precision for surgeons performing these delicate procedures.
Vagus nerve stimulation – Another option for children whose seizures are not well-controlled by medication is vagal nerve stimulation (VNS). VNS controls seizures by sending small pulses to the brain from a nerve in the neck, delivered by a small pacemaker placed under the skin below the collarbone. The stimulator provides an electrical signal on and off throughout the day. For many, this causes a substantial improvement in seizure frequency and severity. The procedure can be considered for children who do not respond to medication, cannot tolerate or do not respond to the ketogenic diet, and are not a candidate for epilepsy surgery.
Each week, our Comprehensive Pediatric Epilepsy Team, made up of board certified pediatric neurologists, neurosurgeons, speech pathologists, neuropsychologists and neuroradiologists, meets to discuss patients being evaluated for epilepsy and make the best treatment decision for each patient. It’s an important opportunity to collect feedback and expertise from the entire epilepsy team.
Our dedicated epilepsy nursing team supports patients throughout their journey, ensuring your care is seamlessly coordinated every step of the way.
Children experiencing neuropsychological problems or difficulties with school performance may be referred to the Mott Children’s Hospital pediatric neuropsychology program for neuropsychological testing, clinical evaluation or therapy. We also work closely with the child developmental behavioral health program for additional consultation on school-related problems.
We offer special expertise caring for children with treatment-resistant epilepsy, including a robust second-opinion service. Our team works closely with your primary care providers to integrate your child’s specialty and primary care as much as possible.
Established patients can be seen closer to home for follow-up care through our Pediatric Epilepsy Telemedicine Clinic, the only program of its kind in the state of Michigan.
Our pediatric neurologists are involved in clinical research to advance our understanding of the causes of epilepsy as well as more effective ways to treat epilepsy. U-M physicians are involved in research around seizures in newborn infants, effectiveness of treatments, and national research into the genetic foundations of epilepsy. We are among the highest enrolling sites for the Pediatric Epilepsy Research Consortium and the Neonatal Seizure Registry.
Take the next step
Schedule an appointment by calling 734-936-4179.