Pediatric Epilepsy Surgery Program
The Pediatric Epilepsy Surgery Program at Children's Hospital of Pittsburgh of UPMC offers comprehensive assessment and care to children with medically refractory epilepsy, care that is on par with the best programs in the nation. On average, we perform brain surgery on 25 patients a year. In addition, about 50 patients a year undergo vagal nerve stimulator implantation. As the only center in the region that provides comprehensive preoperative evaluation, access to the full spectrum of epilepsy surgery procedures, as well as the opportunity to participate in the latest research into epilepsy, the Brain Care Institute offers access to all of the resources required for managing complex epilepsy cases.
Convulsive disorders are among the most common acute and potentially life threatening events encountered in infants and children and is the most common neurologic disorder in childhood. Approximately 5% of children and adolescents in the United States and Western Europe experience a seizure of some type by age 20. Of these patients, only 25% subsequently develop a recurrent seizure disorder, or "epilepsy." The vast majority of children with recurrent seizures either outgrow their seizures or are adequately treated with medication (>80%). In those who continue to have chronic epilepsy, the concern is in those that have medically refractory epilepsy.
Medically intractable seizures have been shown to lead to a decline in the child’s intellectual, behavioral, social and psychiatric development. While the surgical management of for intractable epilepsy has existed for children since the 1950s, recently, more aggressive surgical evaluation and treatment has been advocated in the pediatric population because of the debilitating effects of repeated, uncontrolled seizures on seizures on normal neural development, and specifically, intellectual and psychosocial development. As a result, it has now become standard to consider a surgical intervention as part of the comprehensive evaluation and treatment when medical therapy fails in children, even in early childhood.
While the short-term goal of early surgical intervention is seizure control, the early interruption of epileptic activity aids in preventing further seizure-influenced brain injury. By removing the underlying abnormality causing seizures, the impact of seizures and/or the effect of the often-toxic levels of antiepileptic drugs (AEDs) required for seizure control on brain development is eliminated. Early identification of those children who are unlikely to respond medically increases the chances that earlier surgical evaluation and intervention may interrupt or reduce these detrimental effects.
Medically intractable seizures in childhood present a difficult therapeutic challenge, particularly in light of their effects on the neurological and psychological development in children. Early identification, followed by evaluation and surgical intervention, for those patients who are unlikely to outgrow their seizures or to be controlled with medications, has been shown to improve outcome.
Improved neuroimaging and functional mapping both with imaging and electrophysiologic techniques have enhanced our abilities to earlier identify these children as surgical candidates. Early surgical intervention with a variety of techniques specifically designed to reduce or to eliminate seizure spread or frequency can be performed safely in children with excellent seizure and neurologic outcomes.
While it is a given that the risks of surgery must be considered in any intervention, they must be weighed against a lifetime of seizures and their impact on the developing brain from a functional and cognitive standpoint.
For more information on the Pediatric Epilepsy Surgery Program, please visit the program's webpages on the Children's Hospital of Pittsburgh website, or call 412-692-6928.