Delivering Top-Notch Pediatric Neurological Care Requires Collaboration and Communication

February 28, 2023 | by Jodi McCaffrey
Delivering Top-Notch Pediatric Neurological Care Requires Collaboration and Communication

Pediatric neurology is a complex medical specialty. Diagnosing and treating childhood neurological disorders combines science with art and requires collaboration and communication among patients, parents and providers.

Pediatric neurologists diagnose and treat a variety of neurological conditions affecting children from birth through young adulthood, such as:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism spectrum disorder
  • Cerebral palsy
  • Epilepsy
  • Metabolic disorders
  • Movement disorders, including Tourette syndrome
  • Neuroimmunology disorders, such as multiple sclerosis

In addition to diagnosing and treating the conditions listed above, Pediatrix® Child Neurology Consultants of Austin (CNCA) offers expanded services, including specialized programs for neonatal neurology, headache, sports neurology/concussion, and surgical treatment of epilepsy. Since 2019, it has collaborated with Pediatrix Rheumatology Consultants to manage complicated cases and uses the rheumatology practice’s two outpatient infusion centers.

A Closer Look at Epilepsy Treatment

More than 2 million people in the United States have epilepsy. A neurological condition affecting the brain, the disorder consists of seizures that occur due to disruptions in the brain’s normal electrical activity. Epilepsy can occur at any age but is much more common in children than adults.

The signs and symptoms of seizures can include:

  • Temporary confusion
  • Staring and unresponsiveness
  • Stiffening of the muscles
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness
  • Sudden unexplained falls
  • Psychological symptoms such as fear, anxiety or déjà vu

There is no identifiable cause of epilepsy in about 50% of patients; in most cases, there is a genetic cause that may or may not be more specifically definable. In the other half, the disorder may be linked to:

  • Brain abnormalities, including brain tumors or malformations of brain anatomy
  • Stroke
  • Infections, including meningitis, HIV, viral encephalitis and some parasitic infections
  • Prenatal injury, which can be caused by an infection in the mother, prematurity or an oxygen deficiency
  • Developmental disorders such as autism

“About one-third of the patients we see have a genetically diagnosable disease,” explained Karen Keough, M.D., a board-certified, fellowship-trained pediatrician and child neurologist with CNCA. “Because genetic diagnoses are now more commonly identifiable, new medicines have been developed to address these specific types of epilepsy.”

To determine if your child has epilepsy, a provider will review your child’s medical history and specific details about any seizures they have experienced. Testing will include an electroencephalogram (EEG), which measures electrical activity in the brain, and may also include blood tests or an MRI.

Ways to Treat Epilepsy

Several medications help control seizures. The seizures in about half of the patients Dr. Keough sees are fully controlled with the first medication the patient tries, but some patients need to try a few different types to see which works best. If medication doesn’t work, other options for treatment include brain stimulation, cannabidiol (CBD) oil, dietary therapies or brain surgery. Your child’s physician will collaborate with you to determine the best option.

“Sometimes children will outgrow the condition,” said Dr. Keough. “For most patients, medications work best, but epilepsy can’t be managed with traditional therapies in about one-third of cases. We evaluate these patients for surgery, and only 20% to 30% are candidates for surgical intervention.”

The practice determines if surgery is a good fit for a patient through its six-bed, level IV epilepsy monitoring unit at North Austin Medical Center (NAMC). The unit is operated jointly with NAMC’s adult epilepsy surgery program. While most parents are reluctant to explore surgical options at first, knowing that surgery can cure their child of epilepsy compels them to reconsider. However, not every child is a candidate for epilepsy surgery. In fact, of the 250 children monitored on the unit last year, only five went on to have surgery.

Doctors classify seizures as either focal or generalized based on how and where the abnormal brain activity begins. When seizures are caused by abnormal activity in just one area of the brain, they’re called focal seizures. Seizures that appear to involve all areas of the brain from the start are called generalized seizures. Because of these differences in epilepsy types, there are two approaches to surgery. Open surgery involves removing the brain’s abnormal tissue, while the less-invasive option uses a laser catheter to target smaller, well-defined areas of abnormality.

Dr. Keough points to a recent success story to illustrate the healing power of brain surgery for epilepsy. During his first few years of life, a patient experienced severe seizures caused by a stroke he had just after birth. His development was delayed in all areas. At 3 years old, he was nearly non-verbal, angry and easily agitated. Dr. Keough prescribed various medications and CBD oil, but none worked well enough and the seizures returned. Then she recommended surgery to treat his seizures.

Because his stroke affected only one side of his brain, Dr. Keough thought there was a strong possibility that the patient’s developmental and behavioral issues would improve once the affected side of the brain was removed. So, in December 2021, the patient underwent a hemispherotomy, a procedure in which the damaged half of the brain is surgically disconnected from the healthy half.

Now, he is seizure-free and off all of his epilepsy medications. He is learning, speaking, playing with his sister and engaging with others. His mother reports a “complete positive change in his behavior.”

“I couldn’t be happier for my patient and his parents,” Dr. Keough said. “This is everything we hoped for from his surgery.”

For many patients, however, the solution isn’t always something dramatic like brain surgery. Many times, careful refinement of medications can uncover a treatment that works well at managing seizures. For example, when a patient developed epilepsy after having meningitis, the condition affected her ability to speak and learn. Dr. Keough kept prescribing different medications until they found a combination that alleviated the seizures and decreased many detrimental side effects.

“It’s not always the big, dramatic procedure that makes a difference,” she explained. “Treatment may require a long-term relationship, where we keep trying different things. Sometimes, symptoms get better little by little, then we look back and can see just how far the child has progressed. Not every treatment is an overnight fix.”

Diagnosing Neurological Disorders at Birth

Through a collaboration between the practice and providers in the neonatal intensive care unit (NICU) at St. David’s North Austin Medical Center, CNCA’s neonatal neurology program seeks to identify neurological issues in newborns. Jinfon Ong, M.D., a board-certified, fellowship-trained child neurologist, and Dawn McElvain, CPNP, a pediatric nurse practitioner, worked with Anthony Rudine, M.D., a board-certified, fellowship-trained neonatologist with Pediatrix, to develop the program. Now, all babies admitted to the NICU with neurologic issues are evaluated by a neurologist to catch any potential issues early. The practice also follows up with each patient after they graduate from the NICU.

“We’ve raised our level of engagement with neonatologists to serve more babies and reach more parents,” Dr. Keough explained.

Future Plans

CNCA is looking to add a second pediatric rheumatologist to join Ruy Carrasco, M.D., in growing the group’s rheumatology service. They also plan to add three more neurologists and a fourth epilepsy expert to its elite clinician roster.

“I work with some of the best docs I’ve ever met,” Dr. Keough said. “We formed our practice in 2016 because we knew we could provide better, more responsive and more efficient care. We work with primary care physicians, specialists and advanced practice providers to ensure our patients and their families get top-level care.”

Visit our website to earn more about the pediatric neurology services provided by Pediatrix Medical Group.