Epilepsy is a group of neurological disorders characterized by recurrent seizures. Epilepsy affects children at different ages and to different degrees, from easy-to-control seizures to severe, lifelong challenges.
The Comprehensive Pediatric Epilepsy Program at University of Michigan Health C.S. Mott Children’s Hospital is recognized 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:
- Staring and unresponsiveness
- Loss of consciousness or awareness
- Abrupt or rhythmic movements of the arms and legs
- Stiffening of the body, arms, or legs
- Breathing disruption
- Falling for no apparent reason
- Head nodding
- Periods of rapid blinking
- Unusual behaviors that seem out of place (e.g., mumbling, chewing, wandering)
Seizures may cause problems with:
- Muscle control
- Speech and language
- Vision and other senses
- 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 information about the seizures your child has experienced.
Diagnostic tests will help us formalize a diagnosis, often including some of the following:
- Electroencephalogram (EEG) to measure brain activity during a seizure or between seizures
- Magnetic resonance imaging (MRI), positron emission tomography (PET scan), functional MRI, computerized tomography (CT scan), and/or single photon emission computed tomography (SPECT) to look for brain abnormalities that may be causing seizures
- Blood tests, including routine labs and sometimes genetic or metabolic testing
- 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. We offer routine EEG studies (usually lasting an hour or less), short-term (six-hour) studies, ambulatory (in-home) EEG monitoring and inpatient long-term video EEG monitoring. For more information on what to expect and how to prepare for these tests, please review the following documents:
- Routine EEG
- Short-term Video EEG Monitoring (STM)
- Ambulatory EEG
- Long-term Video EEG Monitoring (LTM)
We perform more than 1,400 inpatient long-term EEG monitoring studies annually. Scheduled admissions for EEG monitoring are used to decide if your child’s events are epileptic seizures, to further classify those seizures, to assess the between-seizure EEG patterns, and for epilepsy surgery evaluations. We also perform EEG monitoring for children in our intensive care units who are suspected to be having seizures.
Long Term Video EEG Monitoring at Mott: What to Expect & How to Prepare
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 across multiple specialties. This includes genetics, metabolism, neurosurgery, developmental behavioral pediatrics, neuropsychology, psychiatry, psychology, social work, nutrition services, speech-language pathology and rehabilitation medicine.
Our approach to caring for children with epilepsy is centered on reducing or eliminating seizures in a way that minimizes interference with a child’s development and daily functioning.
The good news is that treatment is usually very effective for children with epilepsy.
- Medication – More than half 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 seizure control, and monitoring children 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, medically-supervised diet that may be appropriate for children with certain types of epilepsy and children who do not respond well to standard medication therapies. The diet is high in fat, and low in carbohydrates and protein. Our ketogenic diet team includes neurologists, dietitians, social workers, pharmacists, nurses, 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. Learn more about starting the ketogenic diet at Mott.
- Resective Surgery – In many cases, surgery can either eliminate seizures 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 presurgical evaluation is designed to pinpoint where in the brain seizures are starting and assess how removing that tissue might affect 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. C.S. Mott Children’s Hospital offers an intraoperative MRI operating room for epilepsy surgery patients, which allows for a higher level of precision for surgeons performing these delicate procedures.
- Neurostimulation Devices – When the part of the brain causing seizures cannot be precisely identified or cannot be safely removed, a child may be a candidate for an implantable neurostimulator. These devices all deliver mild electrical stimulation to the brain to stop or reduce epileptic seizures. There are currently three neurostimulation therapies available:
- Vagus Nerve Stimulation (VNS) – A pulse generator is implanted under the skin in the chest. This connects to a lead that wraps around the vagus nerve in the neck. The VNS sends periodic stimulation to the brain throughout the day via the vagus nerve. Additionally, a magnet can be used to deliver on-demand stimulation, and the device can be set to provide stimulation in response to a sudden increase in heart rate (a possible sign of a seizure).
- Responsive Neurostimulation (RNS) – The RNS neurostimulator device is embedded in the skull, and electrode strips or depth electrodes are implanted near one or two seizure foci. The device constantly records the electrical activity in the targeted areas and delivers stimulation directly to them when the early signs of a seizure are detected. The timing of this stimulation can be adjusted based on analysis of the recordings.
- Deep Brain Stimulation (DBS) – Two leads are inserted into a deep brain structure called the thalamus, which is thought to play a role in many types of epilepsy. These leads are connected to a neurostimulator, implanted under the skin in the chest, that periodically stimulates the thalamus. The device can also deliver on-demand stimulation and record electrical activity in this region of the brain.
Each week, our Comprehensive Pediatric Epilepsy Team, made up of board-certified pediatric neurologists and epileptologists, neurosurgeons, speech-language pathologists, neuropsychologists, social workers, and neuroradiologists, meets to discuss patients being evaluated for epilepsy and make the best treatment decision for each patient. This is 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. Patients with epilepsy and their families also benefit from the attention of our world-class child and family life and social work teams.
Epilepsy can sometimes impact memory, attention, or other cognitive functions. Children experiencing such problems or difficulties with school performance may be referred to the Mott 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.
Additionally, children with epilepsy are at increased risk for depression, anxiety disorders, and other mental health challenges. We work closely with our social work, psychology, and psychiatry departments to identify these conditions and ensure that appropriate treatment is received.
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.
Our pediatric neurologists are actively engaged in research to advance our understanding of the causes of epilepsy and develop more effective ways to treat epilepsy. U-M physicians are involved in research around seizures in newborn infants, effectiveness of treatments, the genetic and electrophysiological foundations of epilepsy, and other important areas. We are among the highest enrolling sites for the Pediatric Epilepsy Research Consortium and the Neonatal Seizure Registry.
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Schedule an appointment by calling 734-936-4179.