Pediatric Epilepsy Center

Pediatric Epilepsy Center

OHSU Doernbecher has Oregon’s only comprehensive center for children and teens with epilepsy and other seizure disorders. We offer your child a full array of pediatric experts in treating this complex condition, plus the latest therapies and technology. Our services include:

  • A collaborative team of pediatric neurologists, neurosurgeons, radiologists, neuropsychologists, nurses, a registered dietician, a teacher liaison and others. They treat every aspect of your child’s condition in one place.
  • A full range of medications, ketogenic diet therapy and one-of-a-kind clinical trials.
  • Comprehensive seizure monitoring and precise brain mapping.
  • World-class surgical expertise aided by leading-edge technology such as a child-dedicated intraoperative MRI scanner.
  • The latest in Vagus nerve stimulation.

Understanding epilepsy

What is epilepsy?

Epilepsy is a complex set of brain disorders in which surges of electrical activity in the brain cause seizures. Epilepsy is diagnosed after patients have two or more seizures. Cases can be mild to severe, with seizures ranging from blank stares to unconsciousness and convulsions.

How many people have it?

Epilepsy is relatively common, affecting about 3 million Americans. About one-third are younger than 18 when diagnosed, and most of these patients are younger than 2. In Oregon, about 500 children a year are diagnosed with epilepsy.

Early diagnosis

Diagnosing and treating epilepsy early is important because uncontrolled seizures can damage the brain, eroding thinking and learning abilities. Treatment also significantly lowers the small risk faced by some patients, mostly adults, of sudden death during or after a seizure.

Treatment at a full-service program such as Doernbecher’s Pediatric Epilepsy Center can also be important because about one-third of patients can’t control seizures with medication alone.

Types of epilepsy

Epilepsy is complicated, with many types and syndromes. Patients can fit into more than one category. Here are some of the ways cases are described.

  • “Generalized epilepsy” affects both sides of the brain. “Partial epilepsy” affects only one area of the brain.
  • “Refractory epilepsy” resists treatment with medication.
  • Some types affect only or mostly children, and others are more common in adults.
  • Some types run in families.
  • In some cases, a brain abnormality can be seen in diagnostic testing or scans. Other times, no physical abnormality can be found.
  • Some types of epilepsy have “triggers” such as stress, flashing lights or lack of sleep.
  • Children outgrow some types. Other types have no cure but can be managed with treatment.
  • In most cases, the underlying cause is unknown.

Types of seizures

Generalized

These affect both sides of the brain.

  • Absence: These are most common in children. They were formerly called “petit mal” seizures. Patients are not aware of their surroundings during the seizure and usually don’t know they’ve had one. There are two subtypes:
    • Simple absence seizures: The person stares into space for a few seconds.
    • Complex absence seizures: The person also has movements such as rapid eye blinking.
  • Atonic: In this type, sometimes called a drop attack, muscles suddenly go limp. The head may drop, the upper body may slump, or the person may fall to the ground. 
  • Clonic: This type causes the person’s limbs to jerk rhythmically.
  • Myoclonic: The person has a brief, sudden jerking of a muscle or muscles, almost always soon after awaking.
  • Tonic: Muscles in the body and limbs suddenly stiffen, most often during sleep.
  • Tonic-clonic: In this type, formerly called a “grand mal” seizure, the person falls unconscious and may cry out. Muscles stiffen, then the limbs jerk rapidly and rhythmically.

Partial or focal

In these seizures, only one part of the brain is affected.

  • Simple: These seizures affect only a small part of the brain and are divided into types:
    • Motor, which results in muscle stiffness or spasms
    • Sensory, which can create strange sensations in vision, hearing, smell, taste or touch
    • Psychological, with unusual memories or feelings
    • Autonomic, which can affect organ functioning, causing symptoms such as an upset stomach
  • Complex: The seizure may start with an aura, such as a visual or auditory cue. Patients then become unaware of their surroundings, appearing to blank out or daydream. The person may make movements or sounds called “automatisms,” such as lip-smacking, fumbling, speaking or moaning.

Secondary generalized

This type starts as a partial or focal seizure and then spreads to both sides of the brain.

Diagnosis and treatment

Our pediatric neurologists, neurosurgeons and other specialists include national leaders in treating epilepsy, with team-based care all in one place.

Assessment

Diagnosis includes examination by a pediatric neurologist, complex brain imaging, and a thorough assessment by a pediatric neuropsychologist of your child’s thinking abilities and development.

Comprehensive seizure monitoring

We have the most sophisticated, high-resolution imaging and brain mapping equipment to identify the precise source of seizures. This includes state-of-the-art SPECT fusion imaging, which gives doctors a high-resolution look at the brain’s blood flow during a seizure.

Medication

We offer a full range of anti-epileptic medications, including access to new therapies in clinical trials.

Ketogenic diet therapy

Some children with medication-resistant forms of epilepsy benefit from a ketogenic or modified Atkins diet. Our Ketogenic Clinic includes a pediatric neurologist and a registered dietician.

Surgery

Our team includes world-class pediatric neurosurgeons with international expertise and excellent outcomes in treating epilepsy. Many patients leave the hospital seizure-free. Before we recommend surgery, however, our team of specialists meets to weigh benefits and risks. Our expertise and technology include:

  • Minimally invasive neuroendoscopy, which offers small incisions, less pain and quicker recoveries. We combine this with high-resolution, computer-aided navigation for exceptional precision.
  • Sophisticated brain-mapping techniques that enable surgeons to pinpoint the exact source of seizures so they can treat the abnormal area while protecting healthy tissue. This includes the West Coast’s only child-dedicated intraoperative MRI suite, which provides precise brain mapping during surgery.

Vagus nerve stimulation

We are the largest epilepsy center in Oregon to offer this technology, in  which an implanted pacemaker-like device sends mild electrical pulses to the  brain to prevent seizures. This can be an option when medication doesn’t control seizures and when the root of the seizures can’t be identified.

Hundreds of patients have had this procedure at Doernbecher, with excellent outcomes. A 2012 study of 146 Doernbecher patients published in the Journal of Neurosurgery: Pediatrics found that more than 90 percent had fewer seizures, 50 percent had shorter seizures, and 75 percent needed less medication¹.

¹ "Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence," September 2012, Journal of Neurosurgery: Pediatrics

Research and clinical trials

Doernbecher doctors have done extensive research on epilepsy, gaining  national attention for pioneering work on new types of medications such as cannabinoid derivatives (components of marijuana). We offer patients access to the latest advances, including only-at-Doernbecher clinical trials.

Learn more

Epilepsy and Epilepsy; Information for Families and Friends, Centers for Disease Control and Prevention

Epilepsy Foundation, a nonprofit with a page for parents and an “Epilepsy & My Child Toolkit"