Mass General Renews Focus on Pediatric Epilepsy

Massachusetts General Hospital is increasing its focus on pediatric epilepsy to translate recent advances in surgical diagnostics and treatments made in adult patients to benefit children. The efforts involve opening a new epilepsy surgery referral clinic, adding staff with pediatric neurosurgical expertise, and opening a new multidisciplinary clinic where patients can communicate with all providers together.

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"Mass General has deep experience and expertise in epilepsy research and surgery, and a longstanding pediatric epilepsy program, including world-renowned research programs, dietary treatment programs, and a tuberous sclerosis center," says Mark Richardson, MD, PhD, director of the Functional Neurosurgery Program at Mass General. "Now we are reinvigorating the surgery portion of our pediatric program to bring the most recent advances to younger patients. We're focused on creating one of the most comprehensive and effective pediatric epilepsy programs in the nation."

Team Approach to Pediatric Epilepsy

The program has developed systems to efficiently accept referrals and plan and deliver care, Dr. Richardson explains. Under the new model, a child with epilepsy can be referred directly to Dr. Richardson, Kris Kahle, MD, PhD, director of Pediatric Neurosurgery at Mass General, or Catherine Chu, MD, MA, MMSC, director of Neonatal and Pediatric Continuous Electroencephalography (EEG) Monitoring and the Pediatric Responsive Neurostimulation Clinic at Mass General for Children.

"Epilepsy surgery can be scary for many families, but in appropriately selected patients, can result in a cure and improved cognitive development, which is life-changing. Because of the many developments in epilepsy surgery over the last decade, including minimally invasive options, there is often an opportunity to make a significant impact on quality of life for these children and their families," says Dr. Chu.

At each child's first visit, a team member meets with the child and family to talk about the role of surgery in diagnosing and treating drug-resistant epilepsy. Following this, the child is seen in a multidisciplinary clinic with several members of the team to review the surgical options.

Children treated at Mass General and at Mass General for Children may then receive a multidisciplinary evaluation including:

• Pediatric neuropsychology
• Advanced brain imaging studies
• Video-EEG inpatient assessment
• Discussion of surgical options
  • Stereo-EEG
  • Responsive neurostimulation
  • Deep brain stimulation
  • Laser ablation therapy
• Dedicated nurse and physician assistant staffers who can guide patients through the journey, coordinate appointments and help educate families

"It's a real strength that the pediatric hospital is in the same physical building as the adult epilepsy program and that the pediatric and adult programs are located together," Dr. Richardson says. "Pediatric patients can get the best of both worlds: experts in the newest surgical advances that have been successful in adults and children with epilepsy, combined with specialists in pediatric epilepsy and neurosurgery. It's also a great environment for patients to transfer from pediatric to adult care."

Epilepsy Surgery to Cure Seizures and Allow Normal Development

Many seizure disorders can be controlled by medications, but at least 30% of patients with epilepsy are severely drug-resistant. Typically, more than 50% of patients with epilepsy have not been seizure-free in the past year.

Those patients may find a cure with epilepsy surgery, which aims to remove the tissue causing seizures, allowing children a greater chance and normal development and adults a greater chance of avoiding seizure-related cognitive decline, Dr. Richardson explains.

Mass General has made significant advances in these surgeries, including intracranial EEG and device implantation. The hospital uses a detailed process to locate the precise location of seizure origin and determine which patients may benefit from surgical intervention. The team uses intracranial EEG that uses thin electrodes placed directly on or into the brain to record electrical activity. An important part of treatment planning, intracranial EEG can show whether seizures are focal or generalized, whether they are being caused by a lesion and how to avoid functional impairment after surgery.

Responsive Neurostimulation Devices to Prevent and Stop Seizures

In complex cases, identifying one particular area of the brain that is causing seizures can prove challenging. For that population, Mass General has started a new pediatric responsive neurostimulation clinic.

"This treatment involves implantation of a device that can detect an individual's unique seizure activity and respond with electrical stimulation to prevent or abort seizures," Dr. Richardson says. "It's had great success in improving quality of life and helping children develop normally."

The device also records and reports data to the epilepsy team so they can track treatment response and adjust as needed.

Reassuring Families With a Team Approach

"This new model of care is very reassuring to families living with epilepsy," says Dr. Richardson. "Not only do children benefit from the latest advances in adult epilepsy, but they have a team of experts in pediatric neurosurgery closely involved in diagnosis and treatment. And the model provides continuity of care as children eventually grow up and need ongoing monitoring of the chronic condition."

"Our approach reduces the complexity in diagnosing and treating the condition by making the process as efficient and easy to understand as possible," he says. "Families can get the latest expertise in epilepsy surgery with everything a parent would want in terms of child-specific surgical care. We do these cases as partners."

Dr. Chu adds, "Although there are potentially curative treatments available, access to pediatric epilepsy surgery remains a national problem for patients. We are committed to working with our patients and referring physicians to provide education and access to the top treatments available to ensure the best outcomes for children with epilepsy."

Learn more about the Functional Neurosurgery Program

Learn more about the Pediatric Epilepsy Program