Continuing a Pioneering Legacy in Pediatric Epilepsy Care

In the mid-1980s, Nicklaus Children’s Hospital (then known as Miami Children’s Hospital) ushered in a profound shift in the treatment of epilepsy in children. The hospital demonstrated that epilepsy surgery — performed all but exclusively in adults at the time — was a viable treatment option for pediatric patients. Nicklaus Children’s has been a leader in pediatric epilepsy care, especially surgery, ever since.

“We believed there was no reason children should be denied surgery and have to experience convulsions their way through childhood and wait until they were adolescents to have surgery,” says Trevor Resnick, MD, pediatric neurologist and Director of the Nicklaus Children’s Comprehensive Epilepsy Center. “Children are equally capable of tolerating and benefiting from surgery. We went against the tide by pioneering the concept that epilepsy surgery should be performed in childhood the same way as in adulthood.”

Building an Internationally Renowned Center

In 1985, Nicklaus Children’s began building a pediatric epilepsy program that included surgical care options. A 1988 international epilepsy surgery conference at Nicklaus Children’s and a steady stream of program data and practices published in medical literature cemented the hospital’s reputation as a premier center for epilepsy care. Patients from across the U.S., as well as South America, Europe, Asia and Australia sought care at Nicklaus Children’s. Following our example, other pediatric epilepsy surgery centers formed throughout the U.S.

As part of the Nicklaus Children’s Brain Institute, the Comprehensive Epilepsy Center features the full range of medical and surgical care for children with epilepsy. Multidisciplinary care has been a hallmark of the center since its establishment.

“We aren’t just dealing with epilepsy, but epilepsy in children, with all the comorbid disorders that can occur in these young patients,” Dr. Resnick says. “These include developmental delays, autism, cognitive impairment and the psychological impact of seizures, which can affect the entire family.”

In addition to epileptologists, the Comprehensive Epilepsy Center team includes a psychologist, neuropsychologist, speech-language pathologist, pharmacist and pediatric epilepsy nurse practitioner.

Leading-Edge Treatments

We’ve performed more than 1,300 surgeries for medically resistant epilepsy since 1984, achieving several firsts for the field along the way.

“Our major contribution to the field of childhood epilepsy has been in the area of surgery,” Dr. Resnick says. “We’ve continued to publish in this area, specifically regarding non-lesional resections, smaller resections and nonsurgical ablative techniques.”

Our epileptologists use increasingly sophisticated techniques, such as computer-modeled source localization, to locate the seizure focus in patients’ brains. This work also includes the evaluation of epilepsy networks.
“Instead of just saying, ‘We’re going to resect this area,’ we look at a network and decide by evaluating the network of abnormal firing where the node of the network is,” Dr. Resnick says. “If there’s a node that spreads to different areas of the network, and if we get the node, we’re much more likely to be successful in helping the seizures.”

The Comprehensive Epilepsy Center offers leading-edge techniques for epilepsy surgery, including responsive neurostimulation and deep brain stimulation. We were early proponents of treatments that later became standards of care, including laser ablation. A key example of our use of advanced surgical technology is focused ultrasound, which our epileptologists pioneered. This technology allows for the ablation of tissue deep within the brain without needing to surgically navigate through normal tissue.

“Several years ago, we saw data from the use of focused ultrasound in patients with Parkinson’s disease,” Dr. Resnick says. “We thought, if one could do this for patients with that disease, we should be able to use focused ultrasound in epilepsies where we could identify an epileptic focus or an abnormal region deep within the brain.
“Together with three or four other centers in the country, we conducted initial trials of focused ultrasound to ablate hypothalamic hamartomas, which we were able to do successfully. Initially, we did this in patients older than 18, and then we did cases down to age 12 and, finally, age 6.”

In another example of our commitment to innovation, the Comprehensive Epilepsy Center recently began offering transcranial magnetic stimulation (TMS), which allows for noninvasive, preoperative identification of areas of eloquent cortex in the brain. This stimulation helps surgeons understand which areas to preserve during surgery.

“We can use TMS to stimulate eloquent cortex, such as motor or language areas, through the skull,” Dr. Resnick says. “If we can get accurate, localized information about where the language center or motor strip is before we go in to operate, we’re almost 10 steps ahead of the game.”

Considering Connectivity

Understanding the brain’s neural networks — a field known as connectomics — may be key to the future of epilepsy treatment, and the Comprehensive Epilepsy Center is involved in this effort.

“Every area of the brain talks to another area, so we want to know how this network works and interacts,” Dr. Resnick says. “We want to be able to evaluate that using sophisticated imaging techniques and by looking at sophisticated neuronal spread patterns in the brain and computer models for how electrical fields spread.”
We’re also exploring how increasingly advanced electroencephalography (EEG) techniques can reveal information about where seizures originate.

“In the past, we looked at EEGs very specifically between certain frequency bands,” Dr. Resnik says. “Due to newer techniques, we can now look at EEGs at much higher frequencies that give us additional information about areas of abnormality and areas of seizure onset.”

Our team continues searching for novel solutions for epilepsy in young patients.

“We’re here for children,” Dr. Resnick says. “Our team is driven to find newer and better answers for epilepsy surgery in children and to explore new frontiers in epilepsy treatment.”

For more information about the Comprehensive Epilepsy Center, email a physician liaison at Nicklaus Children’s.