Children's Epilepsy

Epilepsy, also known as seizure disorder, is a common disease of the brain affecting about 1 percent of the population, including children and adults. It can affect any person at any age. There are approximately 30,000 patients in Mississippi with epilepsy. Recognized as the state’s only level 4 epilepsy center accredited by the National Association of Epilepsy Centers, UMMC and Children's of Mississippi provide comprehensive testing and treatment for patients of all ages at University Comprehensive Epilepsy Center.

A full complement of advanced diagnostic tests is available for seizures diagnosis, classification, and evaluation for surgical treatment of epilepsy. The center's inpatient epilepsy monitoring unit combines video and EEG monitoring of patients to determine epilepsy type, number and location of seizures. Results of the monitoring tests are supplemented by other diagnostic procedures, including MRI, SPECT, neuropsychological tests, Wada test and PET scanning. Surgical treatments included temporal lobe resection, extratemporal cortical resection, hemispherictomies, corpus callosal resection and deep brain stimulation as well as VNS.

Patients benefit from the intervention of an experienced multidisciplinary team that includes neurologists, neurosurgeons, neurophysiologist, neuroradiologists, EEG technologists, clinical nurse specialists, neuropsychologists and psychiatrists. Any patient who is not responding to medical therapy is appropriate for referral to University Comprehensive Epilepsy Center. Patients may be referred by a physician or self-referred.

Clinical facilities

• Pediatric epilepsy monitoring unit beds for long- or short-term continuous closed-circuit television/electroencephalographic (CCTV/EEG) recording
• Pediatric outpatient ambulatory care facilities
• Pediatric EEG laboratories
• PET scanning facilities
• Anatomic and functional MRI facilities
• SPECT scanning facilities (for ictal and interictal studies)
• Neuropsychology

Clinical services

The professional staff of University Comprehensive Epilepsy Center includes neurologists, pediatric neurologists, neurosurgeons, pediatric neurosurgeons, neuropsychologists, psychiatrists, nurse practitioners, social workers, and EEG technologists - all of whom have special expertise in epilepsy. The staff work with community physicians, other hospitals and community agencies (Epilepsy Foundation in Jackson) to optimize treatment and provide appropriate services for patients with uncontrolled seizures or special problems related to epilepsy.

• Epilepsy Foundation - Mississippi

The facilities at University Comprehensive Epilepsy Center and expertise of the staff allow the staff to:

• Establish a definitive diagnosis in patients with paroxysmal symptoms of uncertain cause;
• Establish optimal medication regimens to maximize seizure control and minimize side-effects;
• Identify patients with medication-resistant seizures for surgical treatment alternatives;
• Localize epileptic brain regions for resective surgery, map vital or eloquent brain areas in relation to the epileptogenic area;
• Perform epilepsy surgery;
• VNS for non-resective surgery;
• Conduct detailed neuropsychological evaluations;
• Monitor antiepileptic drugs and their metabolites in relation to seizures, cognitive function, other drugs, and environmental or physiological factors that affect antiepileptic drug disposition;
• Conduct clinical trials of investigational new drugs;
• Diagnose and treat psychogenic seizures;
• Offer a range of rehabilitation, psychosocial services and referrals.

In addition, the center conducts ongoing clinical research programs in epilepsy as well as new diagnostic methods and treatments.

Epilepsy wellness

• Children with epilepsy are seen in a special clinical setting in the hospital.
• Epilepsy Foundation Mississippi sponsors a monthly support group meeting for Rankin, Hinds and Madison counties. Call (601) 936-5222 for more information.

Assessment and diagnosis

Seizures are sudden episodes of excessive electrical activity in the brain that usually cause a change in behavior and limit daily activities. Using advanced techniques and training, Children's of Mississippi and University Comprehensive Epilepsy Center epilepsy specialists usually are able to identify the disorder after only a single seizure that is not provoked or caused by a specific medical illness. Comprehensive evaluations are used to rule out problems in infants, children and teens whose symptoms resemble those of epilepsy, including stroke-related disorders, migraine, narcolepsy, movement disorders, syncope (fainting) and anxiety.

Medication treatment

Drug-based treatments are provided by Children's of Mississippi and University Comprehensive Epilepsy Center specialists to manage seizures for many young patients with epilepsy or related disorders. Approximately 60 to 70 percent of patients find relief with one or more medications, while many others may be helped with brain surgery or newer surgical procedures.

Clinical pharmacy

There is no known cure for epilepsy, but medications help control seizures in the majority of patients. Our epilepsy team stays up to date on the newest medicines due to its involvement in clinical trials and research. Our pharmacists are trained in the interaction, side-effects and dosing instructions for the various medications.

Surgical treatment

Studies have shown that the earlier in a child’s development that surgery is performed, the better the outcome. Research shows that up to 20 percent of children with epilepsy could benefit from epilepsy surgery. More than 90 percent of children who have epilepsy surgery stop having seizures entirely or see a reduction in the number of seizures.

Some of the types of surgeries performed at Children's of Mississippi include temporal lobe resections, corpus callosotomy, lesionectomy, hemispherectomy, extra-temporal resections, stereotactic ablations and stimulation, multiple subpial transections, surgery for patients with tuberous sclerosis and vagus nerve stimulation therapy (VNS).

Our approach

Neurologists (epileptologist), neurophysiologists, neuroradiologists, neurosurgeons, neuropsychiatrists, nurses, technologists and several other specialized disciplines work as a team carefully selecting patients who will benefit from epilepsy surgery. University Comprehensive Epilepsy Center is a level 4 center with state-of-the-art technology and physicians with specialized training and expertise in epilepsy.

Epilepsy center professionals have devoted their careers to this medical problem. After studying the evaluation data, we design a custom management plan which may include surgery, medical treatment or further testing. The team carries out the treatment, and then conducts long-term follow-up, providing the resources and advice for the best possible outcome. Eliminating seizures is one important result with the overall goal of improving the quality of life for the patient. It is understood that controlling seizures is just one aspect of improving quality of life; managing co-morbidities and social behavior are just as important.

Preoperative diagnostic testing

Specialized studies performed at our center will help to accomplish the important tasks. There are several methods epileptologists and epilepsy surgeons use to localize the seizure onsets and to map brain functions. This is to assure that the seizure focus resection is safely accomplished. 

The preoperative work-up may include non-invasive tests such as magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission computed tomography (SPECT) and video-EEG (VEEG).

By helping to visualize abnormal anatomy and physiology associated with or responsible for seizure onset, a surgical target is defined. Video-EEG recording is the most important test used to characterize seizures and provide possible seizure localization.

There are also invasive tests that involve placing the electrodes directly on the surface or in the brain. These methods may be necessary to provide accurate seizure onset location. They are the most accurate method for defining epileptogenic and normal functioning brain regions. No single test is definitive and can tell us everything we need to know. However, by accumulating information from different sources that confirm and supplement each other, we are able to accurately and safely perform the surgery.

• Non-invasive tests
  Non-invasive tests are ones that do not invade the body or require a surgical procedure and, in general, involve little or no risk. The assessment includes:
  • Electroencephalogram (EEG) recording and video-EEG monitoring - Record epilepsy waves between and during seizures.
  • Neuropsychological study - Assess cognitive (intellectual) strengths and weaknesses, which can help to predict the area from which the seizures arise as well as possible complications of the surgery.
  • Neuro-imaging - Options include, CT scan, MRI, SPECT scan, PET scan, functional MRI and MRS.
• Invasive tests
  Preoperative tests may also include invasive tests. Invasive tests are ones that invade the body. The following is a comprehensive list of preoperative tests performed at University Comprehensive Epilepsy Center:
  • EEG with sphenoidal electrodes
  • EEG with subdural and depth electrode
  • EEG with foramen ovale electrodes
  • Wada test
  • Functional mapping through cortical stimulation

Surgery risks

Epilepsy surgery is not considered unless seizures are not controlled with medications. The surgery has a likelihood of completely controlling the seizures from 50% to 95% of the time depending on the epilepsy syndrome treated and the operation performed.

The benefit of epilepsy surgery is always much better than the circumstance of not pursuing the surgical management. So the decision to have epilepsy surgery usually is based upon consideration of the risks and complications associated with the surgery compared to the risks and complications and quality of life associated with continual uncontrolled seizures. Our epilepsy neurosurgeon will have a thorough discussion with you about all aspects of your operation.