Services & Specialties

Pediatric Epilepsy Care

What is Epilepsy?

Epilepsy is a broad term used for a brain disorder that causes seizures. There are many different types of epilepsy. There are also many different kinds of seizures. Learn more about epilepsy and how to keep children with epilepsy safe.

Seizures are typically classified into two main groups: Generalized Seizures & Focal Seizures

  • Generalized seizures affect both sides of the brain.
  • Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space.
  • Tonic-clonic seizures, also called grand mal seizures, can make a person
    • Cry out.
    • Lose consciousness.
    • Fall to the ground.
    • Have muscle jerks or spasms.

The person may feel tired after a tonic-clonic seizure.

  • Focal seizures are located in just one area of the brain. These seizures are also called partial seizures.
  • Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell.
  • Complex focal seizures can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes.
  • Secondary generalized seizures begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure.

Seizures may last as long as a few minutes.

(CDC, 2020)

Epilepsy Care

Our Pediatric Neurology and Neurosurgery Team has extensive training in treating patients with epilepsy. We review all patient medical history to come up with a thorough plan to ensure your child is receiving the care they need. In addition to seeing our Pediatric Neuroscience Team, this care many consist of having the child undergoing an Electroencephalogram (EEG), Neurocognitive Testing, Autonomic Testing, or having a visit with our Nutritionist and/or Psychologist.  If you are concerned your child may be having seizures, not matter the magnitude, please call our office to schedule a consultation. 

Overview of Services Above

What is Electroencephalogram (EEG)?

An electroencephalogram (EEG) is a test that measures electrical activity in the brain using small, metal discs called electrodes. Our experienced EEG Technologist will attach these tiny electrodes to the scalp (it is pain-free!). The helps the brain cells communicate by sending electrical impulses. Brain cells are active all the time, even when you are asleep. This activity shows up as wavy lines on an EEG recording, that is then interpreted by our Epileptologist. 

Routine EEG (Duration is one-hour)

A Routine EEG is performed in the office with one of our experience EEG Technologists. After the EEG tech places on the electrodes, the recording system will run for approximately 1 hour. During this time, the EEG Tech will be working with the patient to capture brain activity as they undergo common stimulations, photic stimulation (fast, flashing lights or pattern) and hyperventilation (very quick breathing). 

Overnight EEG (Duration is approximately 16 hours)

An Overnight EEG may also be performed in the office. We have two Overnight EEG spaces that have full bathrooms, TVs, beds, a crib if necessary and comfortable chair for parents to stay the night. Our EEG Technologist is trained to stay overnight in our facility to monitor the patient. During this time the EEG Tech will place on the electrodes and perform similar stimulations as they do during a one-hour EEG. The electrodes will then remain intact for the duration of the study. At times, due to patients possible moving in their sleep, please be aware an adjustment may need to be made to the electrode in order for us to receive the best possible brain wave recording. An overnight EEG will help us determine when if a patient is have any seizure-like activity while they are asleep, that may not have appeared during their one-hour study. 

Ambulatory EEG (Duration of 24 hours at home)

Ambulatory electroencephalography (aEEG) monitoring is an EEG that is recorded at home.  It has the ability to record for up to 72 hours.  The aEEG increases the chance of recording an event or abnormal changes in the brain wave patterns. With this study, the patient will come into the office first, to have our EEG Technologist place on the electrodes and review the instructions of how to use the Ambulatory EEG monitoring equipment. 

Once the patient’s EEG study is completed, the recording will be reviewed and interpreted by our Epileptologist. We will then share the results with patients at your next visit.

What is Neurocognitive Testing?

 Neurocognitive Testing is an assessment procedure that utilizes scientifically validated, objective, and reliable computerized neuropsychological tests to evaluate the neurocognitive status of patients. The testing covers a range of mental processes from simple motor performance, attention, and memory, to executive functions. Age-standardized scoring of the assessment eliminates variability and rater bias. The assessment can be repeated over time to monitor progression of disease and/or response to treatment. With a epilepsy, this will help our team to evaluate your child’s thinking ability and how different areas and systems of the brain are working. 

A pattern of your child's strengths and weaknesses will be used to help diagnose the type of epilepsy and plan treatment.

The evaluation will assess:

  • Attention and concentration
  • Executive function skills, such as problem solving, abstract reasoning and mental flexibility
  • Intellectual functioning
  • Language
  • Learning and memory
  • Mood and personality
  • Motor skills
  • Visual-spatial skills, such as perception

What is Autonomic Testing?

Autonomic testing is a neurologic procedure in which the function of the autonomic nervous system is evaluated. The autonomic nervous system is the part of the nervous system that controls your breathing, your blood pressure, your heart rate, the movement of your gastrointestinal tract, your skin temperature, and numerous other functions. To assist in the treatment plan of epilepsy, Autonomic Testing may be recommended by your Pediatric Neurologist to see what might be contributing to the epileptic episodes. This is a pain-free test as well! 

Why would we recommend a Nutritionist for Epilepsy?

A balanced diet from different food groups help the body and brain to function, helping us to stay healthy! Our Pediatric Nutritionist can provide you with suggestions on a healthy diet, such as ketogenic diet or modified Atkins diet, that may help reduce the risk of seizures for some people with epilepsy. We will provide you with easy safe recipes to help stay on a healthy track. 

Why would we recommend a Psychologist for Epilepsy?

Pediatric Psychological evaluations are individualized comprehensive assessments that target an individual’s patterns of current functioning to better understand cognitive abilities, socio-emotional functioning, behavior, and/or personality. We may refer you to see our Pediatric Psychologist to assist in finding a psychological intervention to fit the needs of your child. This may include, relaxation therapy, cognitive behavior therapy, and education interventions that have been used in studies to reduce the frequency of seizures and improve the quality the life.

When would we recommend Surgical Evaluation?

Surgical Evaluations

Your child has epilepsy that is resistant to medical therapy, and therefore, may be a candidate for surgical procedures targeted at improving and in some cases, even eliminating, his or her seizures. This is the beginning of a process which can last many months during which we will perform further testing and gather additional information to ensure that surgery will be effective and can be done safely. Our top priority is to rid the patient of seizures without causing permanent neurological problems.

Here are some facts you should know about epilepsy:

FACTS

In about 1/3 patients who suffer with seizures, medicine will not achieve control and the American Academy of Neurology recommends referral to a neurosurgeon to consider surgical options (Weibe 2001, Engel 2012, Dwivedi 2017)
Especially in young children with developing brains, repeated seizure activity and sometimes the medicines used to treat seizures, may impair normal brain development and cognitive functioning (Tai 2016, Vendrame 2009, Freitag 2005).
Many neurologists and pediatricians are not aware of the benefits of surgery, do not properly know how to pick patients who might benefit from surgery, and frequently overestimate the risks (Hakimi 2008). As a result, the Institute of Medicine published a report indicating that we are operating on a small fraction of those patients who could truly benefit and in some cases be cured by surgery (Gumnit 2012, England 2012). Many experts have referred to the underutilization of surgery for patients with epilepsy as a “national disaster.”
*If you decide to proceed down the road of considering surgery, the list provide on the back of this page has several important items to help you navigate this lengthy process:

Surgical Process

In addition to brain MRI studies and video EEG monitoring, several other studies may need to be done to determine if a patient is an appropriate candidate for surgery. Altogether this process may take many months.
  • – PET CT scan: this study is performed in the out-patient setting and helps us see abnormally low levels of metabolism in parts of the brain that can be linked to seizure generation
  • – Ictal SPECT: this study generally requires admission to the hospital and shows increased turn-over in areas of the brain that occur at the time of a seizure
  • – MEG scan: one of only about 15 MEG scanners in the country is at Overlook Hospital in Summit, NJ; like an MRI, patients need to be still so you may be instructed to give your child a Benadryl before the procedure to ensure that he/she sleeps and does not move too much
  • – Functional MRI: this helps tell us what parts of the brain are responsible for speech and movement, critical functions to preserve
  • – 3T and/or stealth MRI: 3T MRI uses a high-power magnet and can better detect subtle abnormalities of cortical development; stealth MRI is thin-cut MRI that allows us to perform neuro-navigation (aka “brain GPS”) during surgery
  • – Wada test: this test helps us understand what outcomes are to be expected after epilepsy surgery in regards to speech, memory, cognitive function, and movement
If after performing all the required studies, your child is NOT determined to be a appropriate candidate for brain surgery, that doesn’t mean we can’t still offer treatment.
  • – Special diets (eg. ketogenic diet) can help patients by decreasing the incidence of seizures
  • – A small implant can be placed in the neck called a vagal nerve stimulator (VNS); while this implant rarely cures a patient of epilepsy, it can often significantly reduce the burden of seizures
  • – Patients with epilepsy often suffer from depression, anxiety, poor memory, and problems with concentration and attention; our multi-disciplinary team is trained to identify and address these related problems that affect quality-of-life
Our team works in a collaborative way with neurologists, neuropsychologists, physiatrists, radiologists, and other experts around the state who treat children with seizures.
  • Our chief epilepsy surgeon, The physicians at NJPNI have connections to other surgeons all around the country to assist in expanding our growing knowledge of epilepsy and the surgical and non-surgical options we can provide patients. Almost all operative patients are discussed in multi-disciplinary conferences to obtain a professional consensus.
Download this Epilepsy Information here –
Epilepsy Patient Surgical Information Sheet

Call for a consult today: 

973-326-9000
https://njepilepsy.org/

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Caring for your child's well-being is our number one priority. 
Schedule an appointment with a world-class pediatric neurology and neurosurgery team at NJPNI now.
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NOTICE: This website is for informational purposes only and is not intended as medical advice or as a substitute for a patient/physician relationship.

NJPNI is committed to creating a culturally diverse, inclusive and collaborative community for patients and their families, employees and associates where each person is celebrated and has a sense of equal belonging. See our DEI Statement Page for more information.

NJPNI does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age in admission to, participation in, or receipt of the services and benefits of any of its programs and activities or in employment therein. This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations part 80, 84, and 91.

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