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Novel Techniques Offer Option for Pediatric Patients with Medically Refractory Epilepsy

August 29, 2023
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Pediatric neurosurgeons at Orlando Health Arnold Palmer Hospital for Children are using technologically advanced, minimally invasive surgical procedures to offer one of the nation's most comprehensive treatment programs for medically refractory pediatric epilepsy.

There are 470,000 children with epilepsy nationwide. One in five continue to have uncontrolled seizures despite appropriate anti-epileptic medications (aka drug-resistant epilepsy or DRE). While surgery can provide effective treatment to reduce and often eradicate debilitating seizures, it remains vastly underutilized among DRE patients.

"A misperception still exists among parents and providers that big cranial neurosurgeries are the only surgical option, which is not the case anymore.” says Dr. Ryan Jafrani, a dual fellowship-trained pediatric neurosurgeon at Orlando Health Arnold Palmer.

Ryan Jafrani, MD
Ryan Jafrani, MD

Modern epilepsy therapies are "drastically different" than even 15 years ago, according to Dr. Jafrani, a specialist in stereotactic, functional and minimally invasive epilepsy neurosurgery. Less invasive surgical options for treating epilepsy at Orlando Health include laser interstitial thermal ablation, deep brain stimulation, stereotactic radio-frequency ablation, endoscopic disconnections and responsive neuro-stimulation.

Stereo-electroencephalography or SEEG is a procedure that helps guide DRE treatment via minimally invasive implantation of electrodes in the brain to study a patient's unique neurophysiology. This technology doesn't require a craniotomy and enables surgeons to record areas of the brain previously difficult to access.

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"SEEG gives us the ability to now define the epileptogenic zone of seizure onset and map the epileptogenic network to pinpoint the exact tissue to treat with the best method available,” says Dr. Jafrani. "With the advancements we have at Orlando Health, I can now do a focal treatment on what were recently considered incurable, multifocal or generalized epilepsies and dramatically improve a child's developmental trajectory'.'

The Pediatric Epilepsy Center at Orlando Health Arnold Palmer, part of the Leon Pediatric Neuroscience Center of Excellence, is designated as a Level 4 Epilepsy Center, the highest rating by the National Association of Epilepsy Centers (NAEC). Skilled pediatric neurologists, neurosurgeons, nurse practitioners, ketogenic dietary nutritionists and neuropsychologists collaborate to develop individualized solutions for all aspects of pediatric epileptic disease.

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