Nicklaus Children's Hospital began providing comprehensive care, including surgical intervention, for complex pediatric epilepsy years before the program was formalized thirty-five years ago. This early adoption made Nicklaus Children's Pediatric Epilepsy Center the first pediatric center to perform epilepsy surgery to completely stop children from having seizures.

“From day one, our program was groundbreaking, and it all started with the principle of advancing care for these children,” says Matt Lallas, MD, pediatric neurologist and epileptologist at the Nicklaus Children's Hospital Brain Institute. “Since then, we've utilized technology more and more to bring new techniques for children in and beyond our country.”

An Expansive, Expanding Team Approach

Accredited as a Level 4 pediatric epilepsy center by the National Association of Epilepsy Centers (NAEC), Nicklaus Children's offers the full scope of inpatient and outpatient epilepsy services to children affected by this incurable disease. As the phrase suggests, comprehensive epilepsy care requires a multidisciplinary team. Led by a pediatric neurologist, other team members that aid in epilepsy care at Nicklaus Children's include:

• Child Life Specialists

• Clinical Research Staff

• Dietitians

• EEG Technologists

• Geneticists

• Neuropsychologists

• Neuroradiologists

• Neurosurgeons

• Physician Assistants and Nurse Practitioners

• Social Workers

“It's a team that becomes more expansive as you realize epilepsy is about more than seizure care,” Dr. Lallas says. “Proper epilepsy care aims to reduce or eliminate seizures and promote positive long-term developmental outcomes and maximized quality of life.”

Comprehensive Therapeutic Options

This wide-reaching team of experts ensures children living with epilepsy have immediate access to options that address their specific needs, as Dr. Lallas notes that “all children with epilepsy are not candidates for the same therapy.” In some children, such as Tomas, a ketogenic diet brings significant symptomatic relief. Others require medical therapy or surgical intervention.

When a child is a surgical candidate, MRI scans can visualize the brain's anatomy, while EEG, PET and SPECT scans can visualize the brain's function. Combining these technologies can pinpoint the location of the seizure source. The team may then recommend one of the following:

• Intracranial recording. Neurosurgeons place subdural grids on the surface of the brain or stereo EEG electrodes within the brain in the appropriate cortical regions. ROSA® technology provides visual guidance and provides precise placement.

• MRI-guided laser ablations. A fiber optic laser focused on the brain region causing seizures destroys the unhealthy tissue and brings symptomatic relief. Experts at Nicklaus Children's were the first in the Southeast to provide this minimally invasive treatment.

• Functional hemispherectomy. The neurosurgeon disconnects the diseased portion of the brain from the healthy portion. As stated in Neurosurgical Focus, this procedure “is an effective procedure for the control of unilateral medically refractory epilepsy.”

The regular use of genetic testing makes it possible to begin epilepsy treatment with greater certainty and efficacy. Genetic testing identifies unique medication pathways that match the patient's genetic disposition and, therefore, reap positive results. It also classifies patients who may benefit from novel therapies or surgical approaches offered only in clinical trials, which are ongoing at Nicklaus Children's.

“Traditionally, clinical trials are reserved for major academic centers with significant resources,” Dr. Lallas says. “Nicklaus Children's, on the other hand, is a regional pediatric referral center with a long-standing commitment to the boundaries in epilepsy care. We have strong relationships with nearby universities and—more importantly—a commitment to performing advanced care at a scale realized at few institutions.”

As a result of this commitment, clinicians at Nicklaus Children's perform even the most complex surgeries at high frequency and pioneer new approaches that later become accepted best practices across the specialty.

Creating a Healthy Future

The Pediatric Epilepsy Center's goal is to minimize the impact of epilepsy on affected children and families. Under the care of the neurology team, approximately two-thirds achieve symptomatic remediation with medication alone. Surgical intervention may help other patients become seizure-free, and neuromodulation can help reduce the rate of seizures experienced without eliminating seizures altogether.

From Dr. Lallas' perspective, with fewer seizures, children have the opportunity for a richer quality of life with more happy memories and healthy experiences for the whole family. Guiding children towards their most positive potential drives the team of compassionate clinicians at Nicklaus Children's.

“I'm very fortunate to work with like-minded people who want to help children in a comprehensive way,” Dr. Lallas says. “When we do that, we make a difference in kids' lives and their families.”

Email a Nicklaus Children's physician liaison to refer a patient for epilepsy care at Nicklaus Children's.