Guerin Children’s Offers Comprehensive Care for Children With Epilepsy
Understanding of neurological disease is at a crucial juncture, according to pediatric neurologist Deborah Holder, MD. Holder leads Cedars-Sinai Guerin Children’s new Pediatric Epilepsy Program and early-onset clinic, and she is leveraging leaps in her field to benefit children.
“We have a window of opportunity to stop seizures while a child’s brain is still developing, so they can have the best opportunity in life,” she said.
Epilepsy can present as a convulsive seizure, which can be alarming to parents and children. It can also appear as unusual staring and fogginess—subtle symptoms that may slip under even a provider’s radar.
Either way, studies suggest that diagnosis often lags. Follow-up can be challenging, with few pediatric specialists available to identify diverse symptoms and tailor appropriate treatments. Inconsistent care can also add to lengthy hospitalizations for the approximately 470,000 U.S. children who have epilepsy, according to the Centers for Disease Control and Prevention.
Left unresolved over the long term, severe seizures harm brain function and can lead to developmental delays.
However, there is room for excitement in this field, said Holder, who has more than two decades of clinical care, research and advocacy experience in pediatric epileptology.
Full Spectrum of Medical and Surgical Care
The Pediatric Epilepsy Program at Guerin Children’s, which launched in August, offers robust, interdisciplinary neurological care in one place, from the most effective anti-seizure medications to laser ablation.
About half of children can become seizure-free with one medication, with a another 15% fully recovering with two drugs, Holder noted.
Those with serious, treatment-resistant epilepsy—30% to 35%—now have options, as well.
The Guerin Children’s neurological team evaluates these patients in its state-of-the-art, four-room epilepsy monitoring unit to determine where the seizures originate and assess if a child might be a surgical candidate.
One option for regional disease uses an MRI machine and laser to fence off and heat the affected area in the brain, blocking future seizures. The minimally invasive procedure offers next-day recovery, which is quicker than traditional surgery.
With neurosurgeon David Bonda, MD, set to join the program in October, pediatric epilepsy patients will also have access to surgical implantation of neuromodulation devices. The vagus nerve stimulator (VNS) and NeuroPace RNS System function as “pacemakers,” sending electrical pulses to the brain to prevent or shorten focal seizures.
Supportive diet therapy—also available through the Pediatric Epilepsy Program—has become much more effective as well. Ketogenic diets can reduce disruptive seizures in up to two-thirds of patients, according to Holder, and can be the sole treatment for some.
After the First Seizure
One major benefit Guerin Children’s offers is the ability to follow epilepsy patients throughout their life, so they don’t have to shuffle between physicians as they age.
The program’s new-onset seizure clinic will be key to this approach. Epileptologists conduct rigorous testing including EEG scans, imaging and any necessary metabolic, lab or genetic tests.
The clinic aims to see children within seven to 10 days of their first seizure—and to catch epilepsy as soon as possible, so patients can avoid repeated emergency room trips and waiting for diagnosis and treatment.
“This is a diagnosis that really needs urgent, specialized care,” Holder stressed.
The clinic also can help with concerns of unusual, repetitive movements or behaviors. Pediatricians should ask families to record “funny spells,” and then refer, she noted.
Many children will only have one seizure. For these patients, Guerin Children’s neurologists educate the family and develop an action plan in case it happens again.
Genetics: The Next Frontier
Instead of waiting for a child’s epilepsy diagnosis, the Guerin Children’s program could one day identify neurological problems even sooner—in newborns, long before seizures appear, Holder said.
With more than 500 genes now linked to the condition, the field is making rapid strides.
“Genetic testing has become an indispensable precision medicine tool and has revolutionized our understanding of pediatric epilepsy,” said Pedro Sanchez, MD, director of Pediatric Medical Genetics at Guerin Children’s. “We are now tailoring treatments and recommendations based on a child's unique genetic profile.”
With a simple saliva test, neurogenetic counselors can find mutations among hundreds of genes and predict which treatments will abate or worsen a child’s epilepsy, Sanchez added. Physicians can also identify children at risk of medical problems requiring further specialized screening and care beyond the brain.
These discoveries can be “life changing,” ending seizures altogether for those with genetic predispositions, Holder said.
She hopes to leverage Cedars-Sinai’s nursery to make genetic epilepsy testing routine, like newborn screenings currently done for other treatable conditions. Another goal is to develop key clinical trials advancing gene therapy.
“I can't believe I'm practicing in a world where we can not only make a genetic diagnosis, but now also might be able to cure epilepsy,” she said.
Learn more about Pediatric Neurology at Cedars-Sinai Guerin Children’s. For additional details, contact Deborah Holder, MD.