Comprehensive Pediatric Epilepsy Program (CPEP)
Children’s National Medical Center is one of the largest multidisciplinary epilepsy programs in the country. A national leader in the diagnosis and treatment of epilepsy in children, Children’s has more than 8,000 epilepsy-related patient visits each year. Its innovative, multidisciplinary clinical and research program evaluates and cares for children from the onset of seizures, through novel therapeutic interventions, medications trials, and surgery for children with chronic epilepsy.
Children’s has the largest new onset epilepsy program in the country, treating nearly 400 children with newly-diagnosed seizures each year. Children’s also performs epilepsy surgery on about 40 cases annually, and has earned a reputation for excellent surgical outcomes.
Epilepsy treatment at Children’s includes strong cognitive, behavioral and psychiatric evaluation and support. Treatment not only addresses the problems of difficult-to-control epilepsy, but also the concurrent social, educational and emotional issues faced by children and their families.
CPEP is headed by William Gaillard, Division Chief, Epilepsy and Neurophysiology, Professor of Neurology and Pediatrics at The George Washington University and Professor of Neurology at Georgetown University. Dr. Gaillard is also the associate director, Center for Neuroscience Research at Children’s Research Institute. Dr. Gaillard is an internationally recognized expert in pediatric epilepsy and imaging. He has worked throughout his career to study the effects of childhood epilepsy on brain structure and function. He helped pioneer brain mapping with functional MRI in pediatric populations, and continues that work with a focus on determining the impact of seizures on language, cognitive, behavioral, and emotional development.
Gaillard leads a multidisciplinary team of pediatric epilepsy experts consisting of:
- Pediatric neurologists/epileptologists (neurologists with special training and expertise in epilepsy and clinical neurophysiology)
- Neurosurgeons
- Neuroradiologists
- Child psychiatrists
- Pediatric neuropsychologists
- Social workers
- Nurse practitioners
Several protocols are available to patients with new onset seizures, complex partial seizures, and infantile spasms, as well as other types of epilepsies. A number of programs included in the Comprehensive Pediatric Epilepsy Program offer patients and families a full range of options for evaluation, treatment, and support.
Additionally, Children’s sponsors a week-long, overnight summer camp which is a model for epilepsy camps across the country. Camp Great Rock helps campers with epilepsy ages 7-16 build confidence, independence and self-esteem. This is just one of many innovative education efforts Children’s conducts on a community, regional and national level.
Newly Diagnosed Seizure Clinic
Many times, parents feel overwhelmed when their child is diagnosed with epilepsy. The Newly Diagnosed Seizure Clinic at Children’s National Medical Center helps educate parents about epilepsy, medications and seizure management, and facilitates a partnership between parents and the child's doctor.
This is one of few programs that places special emphasis on children with new onset seizures and newly-diagnosed epilepsy. Its innovative educational program is the only one of its kind in the nation.
Each child is evaluated by child neurologists/epileptologists (child neurologists with special training and expertise in epilepsy and clinical neurophysiology).
An epileptologist, social worker and nurse practitioner specializing in epilepsy provide patient and family seminars in the clinic. Parents will receive supplies, information and resource materials to assist them in managing their child's care. The clinic also gives parents a chance to interact with other parents who have children with epilepsy.
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Ketogenic Diet Program
Certain children who are having problems with seizure medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet.
The Ketogenic Diet Program at Children’s National Medical Center helps children with seizures and their families adopt this diet, which can be challenging to incorporate into daily living.
An interdisciplinary team consisting of neurologists, nutritionists, a nurse practitioner and a social worker help families establish and maintain the diet, closely monitoring the child’s condition. Patients are seen multiple times throughout the year.
It is essential to work with a medical team when adopting this diet, just as a patient would work with a medical team on any other therapeutic approach. Children's epilepsy team supervises patients on this diet to anticipate and manage possible nutritional deficits or other side effects.
Among the conditions treated by the Ketogenic Diet Team are:
- Epilepsy
- Lennox Gastaut syndrome
- Glucose transporter type-1 deficiency
- Pyruvate dehydrogenase deficiency
The ketogenic diet severely restricts the amount of carbohydrates, protein and calories a child is receiving, and instead provides a diet rich in fats. When large amounts of fats are metabolized in the absence of sugar proteins, ketone bodies (chemicals that the body makes when it must break down fat for its energy) accumulate in the blood and appear in the urine. The appearance of these substances is known as ketosis.
For some children, the diet has proven to be effective in reducing or controlling seizures when combined with standard anticonvulsant medications. The actual mechanism of the ketogenic diet's effectiveness against seizures is unknown. But when it works, many children can have their epilepsy medication dose lowered, decreasing unwanted medication side effects.
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Vagal Nerve Stimulator (VNS) Program
Some children, whose seizures are not well-controlled with seizure medications, may benefit from a procedure called vagal nerve stimulation (VNS).
VNS attempts to control seizures by sending small pulses of current to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send impulses every few minutes to the brain. When the child feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many people, this will help stop the seizure.
The Vagal Nerve Stimulator (VNS) Program at Children’s National Medical Center monitors patients receiving VNS therapy for epilepsy, and collects data on VNS efficacy and tolerability. The VNS Program now follows approximately 70 patients.
Children’s offers the VNS program at two sites – in the Neurology clinic at Children's National Medical Center - Sheikh Zayed Campus for Advanced Children's Medicine and at the outpatient center in Fairfax, Virginia. Patients and families can have pre-operative visits in either site to learn about the VNS, as well as regular follow-up visits after surgery for VNS programming and monitoring. The actual VNS surgery is done at Children's National Medical Center - Sheikh Zayed Campus for Advanced Children's Medicine by Children’s neurosurgeons.
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Epilepsy Surgical Program
Surgical treatment of epilepsy is usually sought when a child has numerous seizures that cannot be controlled by medications and standard therapy. It is estimated that for 20 percent of children with epilepsy, surgery is their best chance to live seizure-free.
There are various surgical procedures that can be used, but determining which is the right one for any child requires a multidisciplinary epilepsy team, including expert pediatric neurologists, neuroradiologists, and pediatric neurosurgeons.
Children’s neurosurgery team includes nationally-recognized experts in epilepsy surgery – Amanda Yaun, MD and Derek Bruce, MD. The team annually performs about 40 surgeries on children with epilepsy, with excellent outcomes.
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Transition Clinic/Adult Continuity Program
Care of patients should be more than an age category. Neurologists from Children’s National Medical Center, in collaboration with colleagues at Georgetown University Hospital, are providing a smooth transition when an epilepsy patient’s ages are past childhood, but medical issues continue. This pioneering collaboration is a first in the region. The Transition Clinic had its first full year of operation in 2007 and is expanding rapidly.
The Transition Clinic provides continuity of care as epilepsy patients transition to adult care. The clinic provides the resources of neurologists whose experience includes the treatment of childhood epilepsy. The clinic makes appointments through the Georgetown University Hospital (GHU) Department of Neurology, and patients are seen on the Georgetown University Hospital campus.
Transition Clinic Services
Three epilepsy specialists from Children’s National Medical Center staff the clinic together with Georgetown neurologists. That team also makes up Georgetown University Hospital’s Comprehensive Epilepsy Program.
Care includes:
- Evaluations for seizure, convulsion, epilepsy
- Management of epilepsy and refractory epilepsy
- Diagnostic evaluations for epilepsy and related disorders
- Second opinion or management consultations for epilepsy
- Outpatient electroencephalogram (EEG)
- Inpatient video EEG monitoring
- Pre-surgical evaluation of epilepsy
- Vagal nerve stimulator (VNS) placement and management
- Surgical management of refractory epilepsy
- Assistance with epilepsy management prior to or during pregnancy
- Evaluation for potential study participation
Epilepsy Research at Children’s
In addition to being a leader in multi-disciplinary research, Children's National also has close working relationships with the Clinical Epilepsy Section of the National Institutes of Health, and the Center for Treatment of Epilepsy and Related Disorders at Georgetown University Hospital and Medstar Medical systems. Both independently and in collaboration with these partners, Children’s is conducting clinical studies on numerous aspects of epilepsy, its diagnosis, and treatment.
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