Epilepsy, a common neurological disorder, can be a devastating disease for children, not only physically but emotionally. Children and their families often don’t know when seizures will occur and how often they will recur. That can lead to a lot of additional stress and anxiety at school. Some families may feel helpless.
Over the last 10 years, many improvements have been made—whether they are drug therapies, neuromodulators, or surgery. H. Westley Phillips, MD, pediatric neurosurgeon, describes the many innovations in care and offers hope to families who may be struggling.
How did you get into this field?
Phillips: It was a parallel but separate journey. In college, I became very fascinated with the brain and started doing research on connectivity and neural networks. At the same time, I was a college football player when conversations surrounding concussions were beginning to receive national attention. So, I began to develop a passion for learning about neurologic disease and thinking about how I could become a provider for neurological care. That led me to complete a Fulbright Scholarship, where I studied the molecular physiology of the hippocampus, a brain structure often implicated in epilepsy networks.
I realized I wanted to treat children early in medical school. I love their resiliency and the privilege to impact a child’s trajectory in life by treating their disease at an early stage, which can afford them a life’s worth of possibility and potential. As a neurosurgical resident, I received exposure to epilepsy and instantly had my “aha!” moment where I found a way to merge my clinical and scientific passions. From that point on, I became dedicated to a career as a pediatric epilepsy surgeon. This led me to seek additional training in pediatric epilepsy surgery while developing a research program dedicated to understanding the molecular genetic underpinnings of epilepsy to help children lead happy, healthy lives.
What are some of the innovations in epilepsy treatment that are leading to improved outcomes for children and teens?
Phillips: The innovations that are leading to improved outcomes are twofold. First are techniques such as innovative imaging or intracranial monitoring via stereo EEG which have improved our ability to localize the seizure onset zone and therefore treat epileptogenic regions. Stereo EEG and other techniques such as laser ablation have also afforded us the ability to treat some forms of epilepsy in a minimally invasive fashion, obviating the need for bigger surgeries.
Additionally, we are expanding our impact by being able to provide palliative solutions for more types of epilepsy than before. Patients who 10 years ago may have been deemed inoperable now have options that can help their seizures in the form of neuromodulation. We’re doing a lot of work looking at vagus nerve stimulators, responsive neurostimulation, and deep brain stimulation as ways to treat epilepsy and ways to treat subsets of epilepsy that may not have been thought to be surgical candidates before.
What treatment options are available for children who may be struggling with epilepsy?
Phillips: Families should know there is hope. Epilepsy surgery for drug-resistant epilepsy, or when medicines don’t control seizures, is the most underutilized proven medical intervention across all of medicine. Surgery plays a major role in the treatment of drug-resistant epilepsy. It does not have to be the last resort, and there are many cases where surgery is at the forefront of the treatment that patients should have. So, I can’t stress enough the importance of potential surgical interventions that can get patients better earlier rather than later.
Studies have shown that the longer a child has ongoing recurrent seizures, the worse the neuropsychological outcomes are, so treating children early is incredibly important.
What types of outcomes do children face if they have poorly controlled epilepsy?
Phillips: There are cognitive delays and declines. In severe cases, we see neurological deficits that are a result of ongoing recurrent seizures. That has a very dramatic negative impact on the brain’s development, especially in young children. There’s also the social and emotional impact—the stress of not knowing the next seizure is coming, not being able to drive, the fear of going to school and having a seizure while in class. The negative impact of unprovoked seizures is manifold and life-changing.
What is some of the work being done to improve epilepsy care?
Phillips: After a patient fails two medications, the chance of treating seizures with medications drops tremendously—some would estimate a less than 5% chance of medication-driven seizure freedom. We know that when compared to medical management alone, for these cases, surgery often works and has good outcomes.
In terms of long-term outcomes, which are 10 years or more later, what we have seen is that there is still work to be done because the durability of current surgical interventions seems to wane with time. That is a part of my motivation and dedication to understanding the underlying mechanisms of epilepsy. I want to find novel treatment paradigms that will allow us to improve these outcomes for young patients, both in the short and long term.
