The Evaluation Process

The majority of children with epilepsy can be treated successfully with medication. Because we have a reputation for dealing successfully with complex cases, many of our children come to us with seizures that have remained uncontrolled despite medication. Each child goes through an extensive evaluation process, which we individualize according to the complexity and particulars of that child's problem. We strongly believe that your child's best chance for successful therapy depends on accurate diagnosis that only an individualized evaluation can provide and the more precise images that lead to improved surgical evaluation.

Initial diagnostic testing

Depending on the child's history, physical and neurological examinations, the epilepsy team may order limited diagnostic testing for the child during the first visit. In other cases, physicians wait to see if the child responds well to the new medication(s) prior to ordering more diagnostic testing. Initial diagnostics often consist of an EEG, specialized MRI studies, and blood tests. Many of our patients have had tests done at other health care institutions. To minimize the child's discomfort, we do not repeat these tests unless absolutely necessary. Parents can help their child avoid duplicate testing by bringing all prior test results to their child's first visit.

Advanced diagnostic testing: EEG studies

EEG abnormalities, like seizures, may be intermittent and, consequently, missed in a brief routine EEG. When a child has intractable epilepsy or there is uncertainty regarding the diagnosis, the next diagnostic step is to obtain a more comprehensive series of EEGs. The child may be equipped with a portable EEG monitor that can be worn at home throughout daily activities and sleep, or the child may need to be admitted to the hospital for more detailed assessment that combines EEG monitoring with detailed videotaping (video EEG monitoring). Hospital-based monitoring lasts from one day to as long as several weeks. During this time, anti-epileptic drugs may be gradually withdrawn so the most complete picture of the child's seizures can be constructed in a safe, controlled setting. Advanced software (digital signal processing based) tools are applied to the EEG analysis, when appropriate.

Evaluating The Child For Surgery

If our epilepsy experts determine that a child has intractable epilepsy and that surgery may be a good option, the next step is to pinpoint the precise location of the brain (focus) in which seizures begin. A leader in the field of non-invasive diagnostic testing, the Pediatric Epilepsy Center offers a comprehensive array of advanced testing modalities to locate the precise source of the seizure. Recent technological advances, some of which we helped pioneer, have vastly improved diagnostic accuracy.

State-of-the-art multimodal imaging

The University of Chicago Hospitals offers the most complete range of multimodality epilepsy imaging in the United States. When routine imaging is not adequate for visualizing a child's difficulties, advanced imaging techniques are employed. Utilizing data from EEG monitoring, MRI scans and PET scans, our mapping experts use computers to create a three-dimensional model of the patient's brain and the location of the epileptic focus. The information derived from these models combined with other data obtained non-invasively enables a greater number of patients to undergo surgery. These tools avoid inaccurately placing the intracranial electrodes. When invasive procedures are required, the model can assist in accurate placement of electrodes inside the brain. The model sometimes identifies patients who can benefit from surgery but who would have been ruled out by conventional methods.

Genetic testing

The University of Chicago has one of the leading Human Genetics Departments in the United States. This group utilizes various means, including specific molecular testing, to identify and better understand brain malformations, an important cause of intractable seizures in children. The Human Genetics Group is one of the world's leading teams in the diagnoses of brain malformations and is very familiar with treatment options for this complex group of children. The University of Chicago team receives substantial National Institute of Health funding for these efforts. The group also helps guide the evaluation of patients with complex metabolic disorders.

Neuropsychological testing

When surgery appears to be a good option for a child, the final phase of evaluation begins. It includes detailed neuropsychological testing to construct a profile of the child's communication, memory, cognitive, self-help, social, and emotional skills. This profile is critical to identifying any potential risks of surgery. The WADA test is used to determine which side of the child's brain controls speech, language, and various forms of memory.

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