In Part 1 of our Epilepsy Q&A, we asked neurosurgeon Dr. Jay Hauptman how brain surgery for epilepsy has evolved in recent years and why major brain surgery for infant Jiana was his first choice for treating her epilepsy. In Part 2 next month we will hear from Dr. Hauptman and Dr. Ghayda Mirzaa about how patients are benefitting from new treatments derived from genetic research underway at Seattle Children’s and the Center for Integrative Brain Research.
“The brain surgery of today is completely different than the brain surgery of 20 years ago. And our understanding of epilepsy is completely different than it was 20 years ago. And because of that, our treatments have become so much better, so much more tailored and so much more effective.” – Dr. Jay Hauptman
Q: Can you explain why a more significant surgery on a young child with epilepsy may be a better approach than a more conservative surgery?
There are a lot of things that we have learned in the last 20 years that have taught us that being aggressive, going for cure, is perhaps the most important thing in the management of epilepsy in children. We know from studies that were done quite some time ago that when children are on two antiseizure medicines — it doesn’t even matter which two those are, they can be the oldest ones that we have in history of epilepsy medicines or the newest ones that just came out of a clinical trial in the last year — and they continue to have seizures, the likelihood of a third or a fourth medicine ending their epilepsy is near zero, less than 5%. Read full post »
Dr. Rusty Novotny is the director of Seattle Children’s Epilepsy Program.
How common is epilepsy?
Rusty Novotny
Dr. Novotny: About 0.6% of kids have active epilepsy. If you imagine an elementary school with 500 students, that’s about 3 kids.
The highest incidence of pediatric seizures is in the newborn period and then it drops dramatically; it’s lowest in adolescence and continues to gradually increase as a function of age. Febrile seizures (from fever) are most common in children between 6 months and 6 years old. We rarely see febrile seizures in kids over 6 years old in the absence of other underlying risk factors. This is great because it means that kids can “outgrow” the risk of a seizure recurrence with febrile seizures and certain types of seizures in epilepsy syndromes we see in children.
One in 10 people will have a seizure at some point in their life. Read full post »
A new algorithm helps PCPs know where to refer patients for concussion at Seattle Children’s.
- Neurology sees patients who have had ongoing headache for over two months, in the absence of a sports injury.
- Sports Medicine sees patients who experienced a sports injury concussion, are at least 6 years old and have not experienced any of the following: hospitalization for more than 24 hours, skull fracture, intracranial hemorrhage, focal neurological deficit or neurosurgery/brain surgery of any kind in the past.
- Rehabilitation Medicine sees all other concussion patients.
Read full post »
By Randall Bly, MD
Summary:
A 6-year-old male was referred to Seattle Children’s by his primary care provider (PCP) for an evaluation of meningoencephalocele and probable cerebrospinal fluid (CSF) leak. The patient received state-of-the-art care at Seattle Children’s from a multidisciplinary care team of physicians and surgeons from the Cranial Base Program, which led to a carefully planned, complex surgery that repaired the leak and resolved his accompanying health problems.
Patient History:
TB is a 6-year old male with a complex medical history, including repairs of his cleft lip and palate from an outside hospital, meningoencephalocele, recurrent meningitis requiring multiple hospital admissions, conductive hearing loss and velopharyngeal insufficiency. His PCP referred him to Seattle Children’s for suspected CSF leak due to his clear nasal drainage, headaches and recurrent meningitis. His episodes of meningitis had been challenging to treat, requiring multiple days of IV antibiotics. Read full post »
A study led by Melissa Melough of Seattle Children’s Research Institute sheds light on the benefits of vitamin D intake by pregnant women to their child’s brain development as well as the significantly higher risk of vitamin D deficiency among pregnant women of color. Vitamin D deficiency is common among the general population but Black women are at higher risk. “I hope our work brings greater awareness to this problem, shows the long-lasting implications of prenatal vitamin D for the child and their neurocognitive development, and highlights that there are certain groups providers should be paying closer attention to,” says Melough.
Read “Vitamin D Levels During Pregnancy Linked with Child IQ, Study Shows Disparities Among Black Women,” On the Pulse, Nov. 2, 2020.
The Neurodevelopmental program has updated its referral guidelines to clarify what services the clinic does and doesn’t offer and how best to refer patients for a successful first visit. Current wait times for first appointments are approximately six months.
Neurodevelopmental hopes its new referral guidelines will help patients to be seen in a timelier manner and be directed to the provider at Seattle Children’s or elsewhere who will best meet their needs. They stress the importance of submitting a referral that is complete in order to help the family’s first visit go smoothly and be as productive as possible. A complete referral includes the following documents, when available:
- Therapy reports (occupational therapy, physical therapy, speech) and early intervention notes
- Questionnaires (M-CHAT, Ages and Stages, Vanderbilt ADHD Diagnostic Rating Scale and other applicable rating scales and/or questionnaires)
- School records or notes, individualized education plan (IEP) or testing results, developmental assessments
- Brain imaging reports
Read full post »
New referral guidelines are now available from Seattle Children’s Neurosciences Center, along with new resources to help manage patients with tic and headache in primary care.
The current wait time for new patients with non-urgent headache or tic is about 3 months. As Seattle Children’s continues its effort to improve access to specialty care for children who most need it, the headache and tic resources from Neurosciences are intended to help patients with these conditions find appropriate care with their primary physician and avoid the longer waits to see a specialist.
Please visit the Neurosciences “Refer a Patient” webpage. Read full post »
Heidi Blume
What are some important things to know about pediatric headaches?
Heidi Blume, MD, MPH, principal investigator, Seattle Children’s: Unfortunately, headaches are very common in pediatrics. One study found that over 10% of school-aged kids and more than 20% of teens had “frequent or severe” headaches in the past year, and about 5% of younger children and 20% of teen girls have migraines.
Headache is a frequent complaint in both primary care and the ED, and many families are afraid that something dangerous, like a tumor or aneurism, is causing headaches. Fortunately, this is very rare.
Many things can contribute to headaches, including genes (family history of migraine), poor sleep, poor hydration or nutrition, stress/anxiety/depression, other medical problems (e.g., anemia, thyroid abnormalities, rheumatological disorders), dental problems, concussion, pregnancy, drug abuse, musculoskeletal pain (e.g., from slouching over a laptop or other screen for hours) or medications (e.g., stimulants or tetracyclines). Thus, it is reasonable to consider workup for other underlying disorders when appropriate in the evaluation of a youth with headaches. Read full post »
Seattle Children’s welcomes epilepsy specialists Dr. Priya Monrad and Dr. Ahmad Marashly to the Epilepsy Program, where they will serve as Epilepsy Monitoring Unit medical director and surgical program director, respectively. They come from Children’s Hospital of Wisconsin and bring a combined 15 years of experience seeing the most complex patients, including those needing surgery. They joined Seattle Children’s this fall.
What are your plans for the epilepsy program at Seattle Children’s?
Dr. Monrad: We have the largest epilepsy program in the Pacific Northwest, but we want to make it more accessible to families, especially to those families living in Washington state south of Seattle. Starting in December, we’ll be seeing patients at our regional clinic in Federal Way for the first time. Previously, we offered epilepsy services only at the main hospital and the Bellevue and Everett regional clinics.
Dr. Marashly: We’re also going to be putting a stronger emphasis on making sure providers in the community have easier access to us and can get their epilepsy-related questions answered. We know PCPs can handle so much of their patients’ epilepsy care if they have a good connection with a specialist when needed. We want to be a resource to them. Read full post »
