Pediatric Epilepsy service

At American Hospital Dubai we provide a dedicated Comprehensive Pediatric Epilepsy service. The service is led by our Pediatric Epileptologist Dr. Ubaid Shah who has over a decade of experience in evaluating patients with epilepsy. The service provides the latest neuro-diagnostic tests to determine the underlying cause and provide the best treatment available.

 

What is Epilepsy?

Description

Epilepsy is a condition of the nervous system in which the person experiences recurrent seizures or convulsions. The seizures occur because of the abnormal signals sent by the cluster cells or neurons in the brain.

Causes

In children epilepsy can be due to abnormal brain development, genetic reasons, head injuries, fever, infection of the brain or its surrounding membranes (meningitis), and hydrocephalus (excess fluid within the brain).

Symptoms

Children with epilepsy may experience strange sensations, emotions, and behavior along with convulsions, muscle spasms, and even loss of consciousness.

Diagnosis

Detailed analysis of the events (semiology) and thorough physical examination may be sufficient to make the diagnosis of epilepsy. Additional tests are usually required to determine the epilepsy type and try to find an underlying cause. An Electroencephalogram (EEG) test may be suggested to check the electrical activity in the brain. An EEG records the brain's electrical activity via electrodes attached to your child's scalp. Children with epilepsy can have irregular electrical activity on their EEG. Scans of the brain, such as an MRI scan or a PET scan may also be done.

Treatment

Treatment of epilepsy depends on the underlying cause. Anti-seizure medications are the mainstay of treatment. Pediatric Neurologists and epileptologists have expertise in determining the best medication depending on the type of epilepsy.

 

What if medications are not working?

One-third of patients with epilepsy can have Drug-Resistant Epilepsy. If medications do not work, your child should be seen by an Epileptologist who has specialized additional expertise to determine the best course of action. The epileptologist may suggest surgery or implanted devices such as vagus nerve stimulators. Some patients with epilepsy may benefit from brain surgery where the abnormal brain cells causing the seizures are removed to control the seizures. In some cases, a device called a vagus nerve stimulator (VNS) is implanted underneath the skin of the chest, like a heart pacemaker, to control the number of seizures experienced. Some children with epilepsy are recommended to follow a special diet called a ketogenic diet to help prevent seizures.

 

First Seizure clinic

‘Funny turns’ are very common in children and may be a manifestation of childhood epilepsy. At the first seizure clinic, we offer a comprehensive evaluation of ‘funny turns’ including clinical assessment, a detailed review of clinical semiology, and other information to arrive at the diagnosis of whether a funny turn is a seizure or not and if a seizure then evaluation of the underlying childhood epilepsy syndrome and recommendation for appropriate treatment.

Children with funny turns should preferably be seen within days of their first ‘seizure’ for several reasons:

• To determine if it was an epileptic seizure as the rate of misdiagnosis varies from 5-23 % in different studies and possible cause(s) that need further investigation.
• To complete a diagnostic evaluation to determine risks for additional seizures.
• To begin appropriate treatment as soon as possible, if there is a high risk for additional seizures.
• In certain syndromes, such as Infantile spasms, Pyridoxine dependent seizures, and Dravet syndrome, early aggressive treatment may change the course of illness

At the First Seizure Clinic children and adolescents will be evaluated to determine:

• the type of seizure
• Identify triggers or What provoked the seizure
• The likelihood of having another one
• The most appropriate diagnostic tests to obtain. If an EEG is needed this can be arranged at the same visit.

 

Complex Epilepsy Clinic

Children and adolescents with difficult-to-control epilepsy are evaluated with a detailed review of the epilepsy type, previous medication review, and opinion about the current management. Every attempt will be made to know the underlying cause of your child’s epilepsy and a tailored treatment will be suggested depending on the cause of epilepsy. Patients will also be assessed for other therapies if their epilepsy is not controlled with a combination of anti-seizure medications.

The alternatives to anti-seizure medication may include a ketogenic diet, Vagal Nerve Stimulation, or Epilepsy surgery. Detailed evaluation of complex epilepsy patients may require further investigations and admission for the dedicated Pediatric Epilepsy Monitoring that can be arranged at the American Hospital Dubai.

 

EEG Services

We provide a range of neuro-diagnostic services in a private child-friendly setting. Our Neurophysiology scientist is trained in pediatric neuro-diagnostic techniques. The services provided include:

• Standard Electroencephalography (EEG)
• Sleep deprived EEG
• Prolonged EEG
• Overnight Video EEG

Standard (Routine) EEG

Usually, a standard EEG test will be done in the clinic room. This study is normally performed in awake patients.

Sleep-deprived EEG

A sleep-deprived EEG test is done when a child has had less sleep than usual, the night before the study (‘sleep deprived’). When patients are sleep deprived, there is a higher chance that abnormal electrical activity (if present) will be detected. Before a sleep-deprived EEG test, school-aged children (>5 years) will be asked to stay up as late as possible (3 hours past the normal bedtime) and to wake up at least 2 hours earlier than normal. Care should be taken and a discussion with your doctor should occur if your sleep deprivation is a trigger for your child’s seizure. In that case, it may be possible just to wake your child up earlier than usual on the day of the EEG test.

Prolonged EEG

Prolonged EEG involves EEG recording for up to 3 hours in an outpatient setting. The procedure is performed at American Hospital Dubai and is ideal for children who need prolonged recording but are not candidates for overnight EEG recording.

Overnight video-EEG study

This study is reserved for selected individuals to capture EEG during a normal awake and sleep state. This study requires admission to The American Hospital Dubai and the video EEG recording occurs overnight. This study is similar to a standard EEG except that it records for a number of hours in the hospital with the ability to capture sleep EEG features and record events suspicious of a seizure.

 

Doctors Panel of Pediatric Epilepsy service

Ubaid Hameed Shah

Consultant Pediatric Neurologist

English, Urdu

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