Comprehensive Pediatric Epilepsy Center

Epilepsy Overview • Seizures and first aid • Focal • Generalized • Landau Kleffner Syndrome (LKS) • Infantile Spasma Diagnosis and Monitoring • Inpatient monitoring unit • Photo tour of our unit • Pediatrics Department • Directions/Parking/Hotels • Contacts Tests • Electroencphalogram (EEG) • Video EEG • Magnetic Resonance Imaging • Functional MRI • WADA • SPECT • PET • Neuropsychological Testing • CT

Seizures and First Aid

Seizures

What is a Seizure?
Everyone’s brain contains neurons, which conduct nerve impulses by means of electricity. A seizure occurs when there is too much electricity and the neurons fire all at once.

What are the Different Kinds of Seizures?
Generalized seizures occur when the abnormal electrical discharges occur in the whole brain. These can appear as jerking or shaking of the whole body or simply staring spells.

Partial seizures occur when the abnormal electrical discharges occur in only one part of the brain, and usually start with one part of the body jerking or twitching. Partial seizures are called complex if there is some impairment of consciousness. They are called simple if there is no impairment of consciousness.

Do Seizures Cause Brain Damage?
No, not usually. Brain damage may occur if the seizures last for a prolonged period of time (over thirty minutes) and then only rarely. Recurrent seizures may make it easier for seizures to recur. The "kindling theory" suggests that the more seizures a person has, the more likely it is that seizures will recur.

Does Brain Damage Cause a Seizure?
Yes, brain damage can cause a seizure.

Seizures are more common in children who had bleeding in their brains at birth or who have cerebral palsy or tumors, or who are mentally retarded.

Can my Child Die from a Seizure?
Yes, but the chance of your child dying from a seizure is very, very small. Death could occur if your child stops breathing during the seizure for more than five minutes.

Why Do Children Get Seizures?
Children get seizures from a variey of causes. These are some of the most common:
• Trauma, such as accidents, falls, being hit in the head
• Congenital (present from birth) brain defects, like bleeding in the brain, disorders of brain development or lack of oxygen at birth or during the pregnancy
• Brain tumors
• Metabolic disorders
• Infection, such as fever, virus, meningitis

Most cases of childhood seizures are idiopathic, that is, we don’t know why they occur. Idiopathic seizures have the best long-term prognosis, both in term of cure and in terms of the absence of long-term complications.

First Aid

What Do I Do When My Child Has a Seizure?
• Turn the child on his or her side
• Do not put anything into his or her mouth
• Protect the child from hurting himself or herself
• Use rectal valium if the seizure lasts for more than five minutes
• Allow the child to wake up naturally afterwards. This period of sleepiness is called the postictal period.

How Do I Stop the Seizures?
Use rectal valium (Diastat Accudial), which can be given at home by the parents or caregivers, to stop seizures lasting more than five minutes. Diastat Accudial can also be used to stop clusters of seizures. (Clusters are recurrent seizures that occur without the child fully regaining consciousness between the seizures.)

If the Diastat Accudial does not stop the seizures, the child should be taken to the emergency room and the neurology team called by the parent and the emergency room personnel.

How Do I Stop the Seizures from Occurring?
You can reduce the chances of seizures occurring by:
• Controlling fever
• Ensuring the child gets adequate sleep and maintains a good sleep schedule
• Ensure the child takes no alcohol or illicit drugs
• Check with the neurologists before giving the child any other medications. Some over-the-counter medications and prescriptions can lower the seizure threshold or make it easier to have a seizure.

What Blood Tests Will Be Done?
The frequency and type of blood work done on the patient will be determined by the doctor. Generally, blood tests for medication levels, liver function, and anemia are done.

Can a Patient with Seizures Drive a Car?
No one whose seizures are uncontrolled should be driving a car. Each state has specific rules for drivers with epilepsy.

Can a Patient with Seizure Drink Alcohol?
Alcohol lowers the seizure threshold and makes it easier for a seizure to occur. It also interacts with many medications.

What Records Should I Keep?
• Keep copies of all test results: MRIs, EEGs, CAT scans, blood work
• Keep the actual MRIs
• Keep a list of medications used, dosages, and any side effects
• Keep a seizure calendar, and keep records of when seizures occur

Different Types of Seizures

Generalized
Generalized seizures occur when abnormal electrical discharges arise from the whole brain at one time. There are many different epileptic syndromes that may be associated with generalized seizures. Generalized seizures were formerly called either petit mal or grand mal. Petit mal are now called absence seizures.

Clinically, these absence seizures look like staring spells and may be very brief, only lasting a few seconds. Grand mal, or generalized tonic-clonic seizures, are what everyone thinks of as seizures -- a person stiff and jerking, often associated with incontinence, drooling, change in color. Again, both types occur when abnormal electrical discharges occur in the whole brain. Myoclonic seizures are another type of generalized seizures: they are jerking movements. Atonic seizures are drop attacks, when a person suddenly loses tone and falls to the ground.

Focal
Partial seizures can be either complex partial or simple partial. Complex partial seizures are associated with a change in the level of consciousness, while simple partial seizures are not. Complex partial seizures may include automatisms: the person does stereotyped repetitive activities, like picking at clothes, walking in circles, etc. Simple partial seizures include activities such as one hand jerking or eye blinking.

What Happens to the Child with LKS?

In most cases, the child has normal early development, including normal development of speech and language. Onset of LKS is usually between three and nine years and the child experiences deterioration in speech and language ability. This loss may be abrupt or gradual over a period of weeks or months and may be mistaken initially for deafness. Many children compensate naturally for the loss of language by using visual cues and gestures, and may initially hide the extent of their disability. The deterioration in skills is often called a regression, as the child seems to have returned to an earlier stage in their development.

There are often associated behavioral changes, including over-activity, reduced concentration span, irritability, tantrums and difficulties with social interaction. The child may also have problems with fine motor coordination and movement. These difficulties are thought to be a direct result of the disease and not simply an emotional reaction by the child to the loss of language. Some children have seizures and these may start before the initial regression.

The course of the illness is variable and not usually life-threatening, but it may significantly affect the child's functioning. Some children recover spontaneously but many require treatment with anti-epileptic medications or steroids. Recovery may be complete, but more often children are left with some degree of persistent difficulties with language, behavior or cognitive skills. The active phase often lasts years, until adolescence. During the active phase, children may experience repeated episodes of regression and recovery. The child's understanding and performance may be highly variable even within the same day. This may be related, in some children, to the treatment with corticosteroids and attempts to wean them.

A British charity, Friends of Landau Kleffner Syndrome, hosts a Website that provides information about LKS and related disorders.

Other events can imitate spasms. These include reflux (a kind of spitting up), tonic movements that occur in children with cerebral palsy, and increased reflexes.

Infantile spasms are usually diagnosed after a video EEG that shows the abnormal hypsarrythmia pattern. Treatment most often consists of (most often) injections of adrenocorticotropic hormone and/or other antiepileptic medications, most commonly topiramate or vigabatrin

The inpatient unit of the Beth Israel Comprehensive Pediatric Epilepsy Program is located in its own wing at Beth Israel Medical Center. It is a state-of-the-art six-bed unit, with its own nurse’s station, dedicated solely to the care of children with epilepsy.

There are two private and two double rooms, a playroom and a family room. Wireless Internet access is available. Each child has his or her own DVD player, CD player and video game system. Two children can be monitored in the playroom, which contains two video EEG hookups.

The family room has Internet access, television, books and cooking facilities, as well as comfortable couches and chairs. The Child Life staff and music therapists are available to comfort and play with all the children. Crafts, games, books, movies and toys, as well as a big-screen TV are located in the playroom.

If your child is being admitted to the Epilepsy Monitoring Unit (EMU), you should both watch the video on epilepsy monitoring. Copies of the video are available in the playroom. It will give you and your child a very clear understanding of what will happen during your stay.

In order to determine whether there is seizure activity, each child has electrodes glued to his or her head with a sticky substance called collidon. This procedure takes about an hour and a half. We recommend that you bring a button down shirt for your child to wear during this procedure, as it is sometimes difficult to get clothes on and off with the electrodes in place.

The procedure is not painful but it sometimes seems long to the children and the collodion has a very pungent odor. The children must remain relatively still during this procedure. For these reasons, we made a video machine or music available for your child to help pass the time. If your child would like a different activity, such as coloring or a puzzle, please let the staff know.

The electrodes will remain on for a period of time decided by the neurology team.

There are doctors, nurses, nurse practitioners, residents, and EEG technicians in the EMU. During your stay in the EMU, your child may have a seizure. If this occurs, please press the event button connected to the electrodes and pouch. There is also a microphone above the bed. Please talk into it when the seizure occurs. For example, say “I think I am seeing a seizure,” or “My child is staring now,” or anything else that might be helpful to the doctors in the evaluation process.

You will also be given a paper called the seizure record. Fill in as much of this form as possible if a seizure occurs.

Beth Israel Pediatrics is located on the 6th floor of the Dazian Pavilion. To get there, enter through the Emergency Room entrance on 16th street between 1st Avenue and Stuyvesant Park.

Visiting Hours
Visiting hours are 12 noon to 8 pm. Only parents have 24-hour visiting privileges.

In order to maintain a restful environment, a maximum of two visitors (including parents) is allowed in the patient's room. Additional visitors can wait either in the family lounge or in the lobby on the 1st floor.

As part of our family-centered care, we welcome one parent or legal guardian to sleep overnight at the bedside with each patient. Given the limited space, we cannot accommodate a second parent or guardian overnight, although they are welcome to continue to visit after visiting hours.

Babies do not have fully developed immune systems and get an infection very easily. For this reason, babies under the age of twelve months are not permitted on the pediatrics floor.

For the health of our patients, sick children may not visit.

Visitors are welcome to eat and drink in the family room, but food and beverages are not permitted in the patient's room.

Visiting children are permitted in the family lounge and the playroom when accompanied and supervised by an adult family member.

Playroom
The playroom is open seven days a week, from 10 am to 6 pm, Monday through Friday, and 9 am to 5 pm on Saturday and Sunday.

The playroom is considered a safe haven for children on the 6th floor. It is a place where children are free to make choices and where no medical procedures occur.

Staff and volunteers can assist your child in finding age-appropriate activities, which help to alleviate much of the stress and fear children often feel when they are in the hospital.

Bedside Activities
Participating in play and recreation is therapeutic and beneficial to your child’s wellbeing. If your child is not able to come to the playroom, a Child Life Specialist or volunteer can bring activities to his or her bedside.

We have a large supply of games, crafts, and toys that can be brought to your child’s room. Our staff will help determine activities based on your child’s interests.

Family Lounge
The family lounge is located at the end of the hallway past the playroom. It is open 24 hours a day.

There is a recliner-rocker and a love seat that also reclines for any parent who needs to take a break. Among the amenities in this room are a flat screen TV, computer, fax, microwave, refrigerator, computer, and coffee pot. We also provide a kosher refrigerator.

Videos and Video Games
We offer seven video game systems and a variety of games for children to use at bedside. They include Nintendo Game Cube, Playstation 2, Xbox, and Nintendo 64.

We also have a computer in the playroom so children can play computer games. All games and systems must be signed out. For the popular systems, only two games can be loaned to a child at one time.

The Louis and Lucille Armstrong Music Therapy Program
Our music therapy staff provides individual and group sessions.

Upon referral, the therapists can see your child individually, or in a group with other patients. The therapy team also accompanies children to procedures.

Each Wednesday at 11 am, a Community Jam Session takes place in the play room. This is a special music gathering for patients, families, and staff and all are welcome.

Videotapes, Audiotapes, and Books
Each bedside has a VCR/DVD system for the children to use, free of charge. Movies are available in the playroom, and must be signed out.

Each bedside also has a CD player. Music cassettes and videos are available for the children’s use, free of charge. They must be signed out.

Children’s books are available in the family lounge.

The Milton and Carroll Petrie Division of Beth Israel Medical Center is located at First Avenue and 16th Street.

Directions by car
Take the FDR Drive (East Side Highway) to 23rd Street. Drive to 14th Street. Turn onto 14th Street. Make a right on 1st Avenue. Make a left on 17th Street.

There is limited meter parking and a limited number of parking spaces at the Beth Israel Garage just off 1st Avenue. The garage is open 24 hours a day, seven days a week.

Parking
Public garages are located at:
17th Street between 1st and 2nd Avenues
333 East 14th Street
200 East 15th Street
130 East 18th Street
245 East 22nd Street

Directions by Subway
The nearest subway station is 14th Street and 1st Avenue (L train). The closest major subway station is Union Square and 14th street. The 4, 5, and 6 trains and the R and N trains all stop at Union Square. You can connect to the L at Union Square, or walk to First Avenue.

Directions by Bus
Use the M14 crosstown bus and get off at 1st Avenue and 14th Street
Use the M15 uptown bus and get off at 1st Avenue and 14th Street
Use the M15 downtown bus and get off at 2nd Avenue and 14th Street

Hotel and Housing Accommodations
• Beth Israel Housing is located at Gilman Hall, 17th Street and 1st Avenue. (212) 523-2752. There are eight studio and two-bedroom bedroom apartments. They are available on a first-come, first-served basis.
• Union Square Inn – 209 East 14th Street between 2nd and 3rd Avenues. (212) 614-0500. 47 rooms with queen or double beds. (Walk-up only)
• Hotel 17 – 225 East 17th Street between 2nd and 3rd Avenues. (212) 475 2845. 120 rooms.
• W New York Union Square Hotel – 201 Park Avenue South at 17th Street. (212) 253- 9119. 270 king size or double rooms.

Edward Conway, Jr., MD, Chairman of Pediatrics, (212) 844-1333
Kathleen Maloney-Lutz, Coordinator, (212) 844-1072
Honey Shields, Director of Child Life, (212) 420-2429