Epilepsy Surgery Evaluation

The goal of the Pediatric Epilepsy Surgery Program at UPMC Children’s Hospital of Pittsburgh is to give every child a chance at seizure freedom, so that they can develop to their fullest potential.

The Pediatric Epilepsy Surgery Program offers complete assessments and care to children with medically refractory epilepsy — care that's on par with the best programs in the nation.

The multiple phase process that we follow to determine whether your child is a good candidate for epilepsy surgery is outlined below.

Phase I: Epilepsy Monitoring Unit

Your doctor might refer your child for Phase 1 if he or she has epilepsy and hasn't had success with other epilepsy treatments.

The Epilepsy Monitoring Unit (EMU) team gives each child an individualized treatment plan that may include any or all of the following tests:

• Video EEG
• SPECT
• PET
• MRI
• Language evaluation
• Neuropsychology test
• Psychiatric evaluation

During your child’s stay in the EMU, we may:

• Taper or stop anti-seizure drugs to allow for seizures to occur.
• Use other triggers — such as sleep interruption or exercise — to bring on a seizure.

After Phase I is complete, multiple physicians review the EEG, SPECT, and other test results. This team will provide their expertise in diagnosing and treating your child’s condition.

Phase I outcomes

A child can have one of three outcomes after completing their Phase I evaluation in the EMU:

1. We'll take the child directly to surgery where surgeons will resect part of the brain.
2. No surgical option is possible. This is either because the abnormal activity isn't confined to one area your child's brain or the abnormal part of the brain is too close to the area in charge of motor or language function.
3. We advance a child to Phase II because we need more information before we can schedule epilepsy surgery.

Phase II: Further Testing Before Epilepsy Surgery

During Phase II, we will perform a craniotomy and place subdural grids — electrodes embedded in a strip of flexible material — directly on the surface of your child's brain.

Your child will spend the first night in the Pediatric Intensive Care Unit (PICU) until we make sure we've stabilized his or her condition.

In the PICU, we'll attach the cables from the grids to a portable EEG and track your child’s brain activity. The EEG tells the doctor where the seizure activity is coming from.

Once stable, your child will spend five to 14 days in the EMU. He or she will have continuous Video EEG (VEEG) monitoring during the length of the stay in the EMU.

Learn how subdural grids help surgeons pinpoint the area of the brain to resect.

Learn more about the Pediatric Epilepsy Surgery Program at UPMC Children’s Hospital of Pittsburgh here.