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.

How often will you be in Federal Way?

Dr. Monrad: Both Dr. Marashly and I will each be there one day a week; I’ll be there alternating Thursdays and Fridays, and Dr. Marashly will be there alternating Tuesdays and Thursdays. Families often wonder if they need to have a hospital visit before being able to see us at the regional clinic, and the answer is no. Our first meeting with a new patient, and subsequent visits, can be right in Federal Way (or Bellevue or Everett).

Are there cases when patients will have to go to Seattle?

Dr. Monrad: In some cases, if a patient at one of our regional clinics needs a CT or MRI, or certain special tests, they’ll need to see us in Seattle. Or if they need a long EEG, we can only do that in Seattle. But most patients don’t need that; the regular EEG is what patients get initially to know how to proceed, and we can do that at the regional clinic. In fact, we are increasing our capacity for EEG testing in Federal Way and will be able to serve more patients there in the future.

Are surgical services expanding too?

Dr. Marashly: Yes, we plan to serve more kids who need surgery. There are a lot of children with epilepsy who would benefit from surgery who don’t get it.  Some kids just don’t know about the option, or they know surgery is available but they don’t have enough information to feel comfortable saying yes. There’s a lot of education needed for families to get to the right decision and ease their anxiety. The time between a child becoming a good candidate for surgery and actually having the surgery can be double-digit years. I want us to identify those patients earlier, help them get any testing they need and give them all the information they need to understand how surgery can help them.

When should a patient be referred to a specialist?  

Dr. Monrad: If a patient has epilepsy, is having seizures or has failed even just one medication, we want to see them as soon as possible. Seeing children as early as possible helps us determine the best treatment.

Dr. Marashly: The most commonly accepted definition for when to refer an epilepsy patient for a surgery evaluation is if they have failed two medications. But if a patient has failed just one medicine, there is still a benefit from seeing an epileptologist to evaluate whether surgery is a good option or simply to optimize the next level of treatment.

What excites you about being an epileptologist?

Dr. Monrad: I have always been interested in metabolic and genetic diseases. It’s part of why I came to Seattle Children’s. There’s such a strong group here in diseases of neurology. Any parent who has a child with an unusual genetic or rare disease knows it can be very isolating because it feels like no one has ever heard of it or can help them, or will even try to manage it. My interest in these uncommon diseases comes from knowing that if it’s your child, it’s important to have someone close by to help them be as healthy as possible.

Dr. Marashly: I’m very interested in research and the clinical trials going on. Right now, Seattle Children’s is involved with an incredible new treatment for neuronal ceroid lipofuscinosis, or NCL, that used to cause terrible seizures and rob children of their ability to walk, talk and see. Even as recently as five years ago, it usually led to death in their school years. But now we have a treatment, and it’s only offered in a few places in the United States. It involves putting in a port that allows us to inject medicine into the brain. We have several teenagers receiving the treatment who are getting to make their own decisions about it. There are a lot of other children with this disease in the Washington, Alaska, Montana, Idaho (WAMI) region who we can help too; they are a tight-knit patient population who are very good about sharing information among themselves and learning about their options. I’m excited at the possibility of reaching more of them.

Learn more about Seattle Children’s Epilepsy Program.