“The Comprehensive Epilepsy Program at Children’s Hospital Los Angeles (CHLA) is a level 4 Pediatric Epilepsy Program in Los Angeles, a level four center is equipped to offer the highest level of care to children with epilepsy. Our goal is to offer individualized diagnosis and treatment options to each patient we evaluate. We strive to improve the quality of life for all children living epilepsy.
Our team consists of experts from multiple specialties, including neurology, neurosurgery, neuropsychology, genetics, nutrition, radiology, anesthesiology, social work, physical and occupational therapy and nursing. We currently have five Pediatric Epileptologists, neurologists specializing in the treatment of epilepsy, who evaluate patients and formulate an individualized treatment plan. A visit with any of these physicians is the starting point of the child’s evaluation. After a thorough history and physical exam the epilepsy specialist will determine what testing is necessary and what treatment options are appropriate.
Our services include an outpatient electroencephalography (EEG) lab staffed by experienced, pediatric trained EEG technologists and an inpatient Epilepsy Monitoring Unit (EMU), monitored 24/7 by trained nurses and technologists. Tests which may be ordered include routine EEG studies which normally last 1 hour, outpatient video/EEG monitoring for 4-6 hours or an inpatient admission to the Epilepsy Monitoring Unit (EMU). The goal of an EMU admission is to record the events the child is experiencing to provide the Epilepsy Team with critical information on what type of seizures the child is having and where in the brain the seizures originate from.
For patients requiring imaging as part of their comprehensive evaluation, our radiology department offers state of the art technology. An Epilepsy Specific protocol is used for each of our patients who undergo a magnetic resonance imaging study (MRI). All studies are performed on a 3Tesla magnet, the strongest currently available, to obtain the highest quality images of the child’s brain. Nuclear medicine studies including Positron Emission Tomography (PET) and Single-Photon Emission Computed Tomography (SPECT) are performed and help physicians identify the region of seizure onset. Functional MRI (fMRI) allows us to determine the areas of the brain that specifically control movement, language or vision. Utilizing sophisticated software EEG data can be transformed into a visual image and combined with a MRI in a process called 3D-Source Localization.
Epilepsy Surgery is routinely offered at the Children’s Hospital Los Angeles. Our epilepsy surgery team includes Pediatric Neurosurgeons who have received dedicated training in the different techniques for Epilepsy Surgery. These techniques include the direct removal of the region of the brain causing seizures a single stage with intraoperative EEG guidance, the implantation of electrodes directly on the brain to record the cerebral activity over a period of days in a two stage procedure that also includes identification of motor and language control regions. Laser ablation procedures are also available. This process allows our team to treat seizures using a laser passed through a small opening in the skull. This minimally invasive procedure offers good results for select patients with a rapid recover.
All patient who undergo an Epilepsy Surgery evaluation will receive testing by a Neuropsychologist. These are professionals who assess the cognitive capabilities of the patient to determine how the brain learns and processes information. This evaluation helps the Epilepsy team determine which region of the brain is the most impacted by the child’s seizures and may help parents receive necessary services to improve the child’s education. Often the recommendations of the Neuropsychologist will help identify techniques to improve the child’s school performance.
Not all patients are candidates for epilepsy surgery. The Epilepsy Program at CHLA also specializes in Vagus Nerve Stimulation (VNS), a device used to treat epilepsy and diet therapy. VNS is an implantable device, placed during an outpatient surgery, which can decrease seizure frequency and shorten individual seizures. The diet therapy program at CHLA is comprehensive, offering all diet options currently being used to treat epilepsy, including low glycemic index, modified Atkins and the ketogenic diet. Our team includes two Registered Dieticians who have years of experience in these treatments, including monitoring for side effects, ensuring adequate intake to support growth and development.
Some patients have Epilepsy due to changes in their genes or chromosomes. Each of our physicians has experience in the identification of these syndromes and may consider testing patient to determine if the epilepsy has a genetic cause. This testing can identify conditions which require specific treatments, or which require avoidance of some medications to prevent worsening. Knowing the gene responsible each child’s epilepsy, when possible, may provide insight into what to expect for the future. A comprehensive Epilepsy Genetics clinic is available at CHLA.
Living with Epilepsy presents many unique challenges to children that parents may not know to handle. Often parents find it difficult to navigate the complexities of the medical evaluation. Our Nurse Care Manager is a vital resource in communicating with the families and with the various members of the Epilepsy team to ensure each child is getting the best in care. There are also times when the needs of the child might include obtaining services for in-school or in-home support in order to help the family. For these reasons, our team includes two Clinical Social Workers who can guide families in how to obtain the resources they need from the local community.
Improving the care of children with Epilepsy and making life better for every child requires research. The physicians at CHLA are actively participating in national research studies, including testing new medications, improving our understanding of the genetic causes of epilepsy and finding new treatments for children with epilepsy. Many of these studies are currently open for enrollment.
At the Children’s Hospital Los Angeles, we understand that every child is unique. Each child’s evaluation and treatment is individualized to meet that child’s specific needs. We cannot always determine before the initial visit which child will benefit from which tests. However, we can guarantee that every child who comes to our program will have the support of a large team of dedicated professionals. Our goal is to improve the quality of life for the children living with epilepsy and their families.
The Epilepsy Program at CHLA is part of the University of California (USC) Epilepsy Consortium. This Consortium brings together Epilepsy Programs across southern California staffed by USC physicians who have the same goal, providing the highest quality of care to our patients. By working together we can improve the quality of care we offer all patients who visit one of the participating centers. One of the major areas of collaboration is research. In addition to treating patients, the physicians of USC are also conducting research in many areas of epilepsy. We are working together to find better ways of diagnosing, treating and one day curing epilepsy. By working together across all of the USC centers we will achieve our goal of no seizures, no side effects”