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Epilepsy Surgery Program

Pediatric ICU
The Milton and Bernice Stern Department of Pediatrics at Beth Israel Hospital is located at 16th Street and First Avenue, on the sixth floor of the Dazian Building. A brand-new, five-bed, state-of-the-art pediatric intensive care unit was built in 2004, at the same time that the pediatric floor was refurbished and the Epilepsy Monitoring Unit was built. Facilities include six beds for epilepsy monitoring, a family lounge, playroom, and wireless Internet access. The units are staffed by attending pediatricians, intensive care specialists, nurse practitioners, family practice residents and neurology- and neurosurgery-trained nurses. A full Child Life program is in place, and social workers are available. Take a Photo Tour of the EMU Unit.

Vagal Nerve Stimulator
Small pulses of electricity are sent to the brain via the vagus nerve, a large nerve in the neck. The surgery entails placement of a small pacemaker in the neck, with wires tunneling up to and around the vagus nerve.

 

Corpus Callosotomy
This surgery is indicated for patients with disabling atonic seizures (drop attacks). The connection between the two sides of the brain (the corpus callosum) is severed, to prevent seizures from spreading.

Cortical Resections
A cortical resection is the removal of a small area of the brain from which the seizures are believed to arise. This resection can be either lesional (if there is a preexisting area of abnormally formed brain, from a stroke or area that never formed properly) or non-lesional (if the seizures begin in a specific area of the brain, without an obvious abnormality). This is done by implanting electrodes for localization of seizure focus and for brain mapping.

Children frequently require electrode implantation to both precisely localize the focus triggering the seizures, and to map regions of the brain important to movement of the body and to speech.

Information gained from previous, non-invasive VEEG monitoring is used to determine what surfaces of the brain must be covered with the electrode sheets (grids) or electrode strips. Rarely, a preliminary surgery is required to better define which regions of the brain are responsible for the seizures. In these cases, strips of electrodes are fed through small holes in the skull to accomplish broad coverage over the brain's surfaces. Coverage to define the focus of the seizure is broad so that all borders of the focus can be delineated. Once the site of origin of the seizures has been determined, the electrode sheet is used to map brain function.

Tests during cortical resections include INTRAOPERATIVE CORTICAL STIMULATION FOR BRAIN MAPPING. This is the type of monitoring typically associated with epilepsy surgery. It may be done either during the surgical procedure on an anesthetized child, or as part of the surgical admission, at the bedside. The motor and speech cortices of the brain are stimulated to confirm their identity or to delineate regions important in higher cortical functioning. This stimulation is done using the previously implanted electrodes. Each of the electrodes on the grid is stimulated to determine which part of the cortex of the brain is responsible for speech and movement.

Temporal Lobectomy
This operation is the most widely used surgical procedure in epilepsy, since the anterior temporal lobe is the most common seizure focus in patients with partial seizures. Approximately 60%-85% of patients who have this operation become seizure-free, and 85% enjoy a marked reduction of seizures.

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