Recognizing Complex Epilepsy in Pediatric Patients

Complex epilepsy carries developmental, safety, and quality-of-life risks that compound the longer the condition goes unmanaged. An experienced pediatric neurologist can help develop a treatment plan for the long-term management of complex epilepsies, which may incorporate dietary modifications, medication trials, and surgical options for refractory epilepsy

Indications that a patient’s epilepsy is complex include:

• Seizures that persist after 2 failed anti-seizure medications
• Multiple seizure types (e.g., focal and generalized seizures, absence and tonic-clonic seizures, etc.)
• Diagnostic uncertainty (seizure type is unclear or suspected to be syndromic)
• Epilepsy with comorbid developmental regression
• Suspected surgical candidacy (focal or drug-resistant seizures)
• Infantile spasms or other high-acuity pediatric syndromes
• Genetic test results indicating developmental and epileptic encephalopathy (DEE).

Patients who meet one or more of these criteria benefit from early referral to a qualified epilepsy center, where they can be assessed for multimodal treatment options.

Studies show that a shorter time between diagnosis of epilepsy and referral for epilepsy surgery is associated with higher rates of seizure freedom in pediatric patients. Because of the assessments required ahead of surgical intervention for epilepsy, early referral is critical to the chances of reducing or eliminating seizures in children with complex epilepsy.  

Guidelines from the National Association of Epilepsy Centers recommend referral to a qualified epilepsy center once 2 antiseizure medications have failed, to ensure that patients who would most benefit from epilepsy surgery can be evaluated as early as possible. This also allows better access for less commonly prescribed medicines for treatment resistant epilepsy, and alternative therapies such as ketogenic diet.

Gillette Children’s, a NAEC Level 3 Epilepsy Center, offers a variety of diagnostic and treatment modalities for children who have complex epilepsy. These include:

• Genetic counseling and testing for developmental and epileptic encephalopathies
• Video EEG (VEEG) monitoring in an ABRET-accredited neurodiagnostic lab
• 3T MRI
• Dietary therapy through our Keto Diet clinic, which includes clinical and pharmacy support for medical ketogenic diet implementation as well as ongoing support and monitoring
• Surgical implantation of neurostimulators such as VNS or DBS
• Resective brain surgery for patients with focal epilepsy
• Palliative neurosurgeries such as corpus callosotomy and hemispherectomy
• A collaborative and multidisciplinary environment to assess and treat other conditions associated with complex epilepsies:
  • Psychology and neuropsychology for learning and mental health concerns
  • Orthopedic and rehabilitation specialists to assess and treat comorbid conditions, such as cerebral palsy and complex movement disorders

To make a referral:

• Phone: 651-400-2525
• Online Referral Form
• Questions? Contact our provider relations liaisons at providerrelations@gillettechildrens.com

Gillette Children’s pediatric neurology and neurosurgery experts are committed to working with you throughout your patient’s epilepsy journey.