Pediatric Epilepsy Care
Epilepsy is a disruption in the electrical system of the brain that results in seizures. The Epilepsy Center at Hackensack University Medical Center is accredited by the National Association of Epilepsy Centers as a Level IV Epilepsy Center—the highest level attainable and an indicator of comprehensive, high-quality care.
When you bring your child to us for epilepsy care, you’ll receive coordinated, comprehensive, and compassionate care from a team of pediatric epilepsy experts who understand the disorder and how it disrupts the lives of your child and your family. We’re not just the right place to go for epilepsy care, but a home for families who may feel desperate to identify the next step in their child’s treatment—whether that is a standard treatment or an innovative approach on the horizon.
Multidisciplinary Care for Children with Epilepsy
We assemble the team of specialists children need to start taking control of seizures, helping them regain function, return to activities, and achieve a good quality of life. Our team includes epileptologists, epilepsy surgeons, dedicated nurses, video EEG technologists, child life specialists (who ease the hospital experience), registered dietitians, psychologists, and social workers. The entire team participates in medical rounds daily to get to know each of our patients. Together they get to know your child and your family so they can personalize the most effective plan of care to control your child’s seizures.
Counseling for Children with Epilepsy
After a diagnosis of epilepsy/seizures, children and their families can experience significant emotional challenges. Epilepsy can co-occur with depression or anxiety. Academics and quality of life can suffer as a result of living with seizures. As children grow up, adhering to medications, health and sleep behaviors, and relationships with peers can suffer. Our counseling psychologists can help children develop the coping skills necessary to live well despite epilepsy.
The Only Dedicated Pediatric Epilepsy Monitoring Unit in New Jersey
The first step in your child’s care is a thorough assessment of symptoms and seizure activity. The Pediatric Epilepsy Monitoring Unit at the Joseph M. Sanzari Children’s Hospital is the cornerstone of our pediatric epilepsy program, and the only dedicated pediatric EMU in New Jersey. Offering 24-hour video EEG, the unit is staffed 24/7 by members of the pediatric epilepsy team.
- Patients and their families stay in state-of-the-art rooms dedicated to safety and comfort.
- Each room is equipped with a large screen TV with entertainment features for your child, as well as Internet access so you and your child can stay in touch with friends and family members.
- Every room has its own bathroom and shower.
Care for All Types of Seizures
A seizure is an uncontrolled, sudden electrical disturbance in the brain that can affect movement, feeling, awareness, and behavior. Epilepsy is a disorder of recurrent and unprovoked seizures. “Provoked” seizures may result from brain injury, high fever, stroke, or a brain tumor. At Hackensack University Medical Center, the epilepsy team evaluates and treats children with all types of seizures, including:
- Focal (partial) seizures, which arise on one side of the brain and can spread to other areas. Before a focal seizure, your child may have an “aura,” or signs that a seizure is about to occur. This is more common with a complex focal seizure. The most common aura involves feelings, such as dèja vu, impending doom, fear, or euphoria. Or your child may have visual changes, hearing abnormalities, or changes in sense of smell.
- Tonic-clonic seizures (“grand mal”): shaking and stiffening of the arms and legs.
- Drop seizures (“atonic seizures”): sudden falling to the ground, leaving the child limp and unresponsive during the seizure.
- Absence seizures (“petit mal”): brief staring spells, at times associated with eyelid flutter or lip smacking. These seizures usually start between ages 4 and 12.
- Myoclonic seizures: lightning-fast jerking of the arms or legs, occurring several times a day or for several days in a row.
How to Know if Your Child Is Having a Seizure
Children experiencing a seizure may display these signs and symptoms:
- Jerking movements of the arms and legs
- Stiffening of the body
- Loss of consciousness
- Breathing problems or stopping breathing
- Loss of bowel or bladder control
- Falling suddenly for no apparent reason, especially with a loss of consciousness
- Not responding to noise or words for brief periods
- Appearing confused or in a haze
- Nodding head rhythmically, when associated with loss of awareness or consciousness
- Periods of rapid eye blinking and staring
The symptoms of a seizure may be like those of other health conditions. Make sure your child sees a healthcare provider for a diagnosis. Your provider will ask about other factors that may influence your child’s seizures, such as recent fever or infection, head injury, birth defects, a history of preterm birth, or recent medications.
Treatment of the Most Complex Cases
The management of epilepsy in children and adolescents can be complex, with the need to try different medications before finding the right one and sometimes needing to incorporate other means of seizure control. At Hackensack University Medical Center, we have exceptional experience in medication management as well as the care of patients who need epilepsy surgery, those following ketogenic diets, and patients with uncontrollable (intractable) epilepsy. We offer:
- Medications to control seizures. We select your child’s medication based on the type of seizure, your child’s age, side effects, cost, and ease of use. Medicines used at home are usually taken by mouth as capsules, tablets, sprinkles, or syrup. Some medicines can be given into the rectum or in the nose. If your child is in the hospital with seizures, we may give medication by injection into a vein. We will periodically do tests to see how well the medication is working, such as blood and urine tests and EEG.
- Surgery to remove or disconnect parts of the brain responsible for seizures. Our epilepsy surgeons have exceptional experience performing these delicate operations.
- Vagus nerve stimulation, the implantation of a device (under the skin of the chest) that generates electrical currents to normalize abnormal brain activity. This may be an option for children age 12 and older who have partial seizures not well controlled with medication.
- Neuropsychological testing helps us understand and improve how epilepsy impacts a child’s thinking and behavior in school and at home. This also helps the team plan for possible surgery.
- Diet therapy about following modified Atkins and ketogenic diets—high-fat and low-carbohydrate diets specifically designed to control seizures. Some children on the ketogenic diet become seizure-free.
Genetic Testing and Counseling
Pediatric epilepsy is sometimes linked to genetic mutations and, in some cases, can be passed on in families. Genetic counselors in our Department of Pediatrics are available to you to evaluate whether your child’s epilepsy is caused by a genetic mutation and determine if there is a mutation that may affect other people in your family. Members of our hospital’s strong metabolic and genetics program have expertise in rare genetic epilepsies, and your child may benefit from their input. Hackensack University Medical Center is one of just three centers participating in a research consortium focused on a rare genetic epilepsy syndrome.
Supporting a Child with Epilepsy
You can help your child with epilepsy manage his or her health. Make sure to:
- If age-appropriate, ensure your child understands the type of seizures he or she has, and the type of medicine that is needed.
- Know the dose, time, and side effects of all medicines. Give your child’s medicine exactly as directed.
- Talk with your child’s healthcare provider before giving your child other medicines. Medicines for seizures can interact with many other medications. This can cause the medicines to not work well, or cause side effects.
- Help your child avoid anything that may trigger a seizure. Make sure your child gets enough sleep, because lack of sleep can trigger a seizure.
- Make sure your child visits his or her healthcare provider regularly. Have your child evaluated as often as needed.
- Keep in mind that your child may not need medicine for life. Talk with your healthcare provider if your child has had no seizures for one to two years.
If your child’s seizures are controlled well, you may not need to restrict any activities. Make sure your child wears a helmet for sports such as skating, hockey, and bike riding and has adult supervision while swimming.
Eric Segal, MD, Neurologist and Epileptologist
Co-Director, Division of Epileptology, Department of Neurology
Eric Segal, MD is an epileptologist with particular expertise in difficult-to-treat epilepsy. He is very experienced in and has published research on rare neurological syndromes such as Dravet, Lennox-Gastaut, Sturge-Weber, and tuberous sclerosis complex. Dr. Segal is actively involved in developing new therapies for epilepsy. When medications are not effective, he regularly utilizes ketogenic diet, epilepsy surgery, and neuromodulation to improve seizures and patients’ quality of life.
He received his medical degree from Albert Einstein College of Medicine where he also completed his pediatric residency. Dr. Segal completed his neurology training at Columbia University Medical Center and neurophysiology at Harvard’s Boston Children’s Hospital. He holds board certifications in Neurology, Clinical Neurophysiology, and Epilepsy. He is also Assistant Professor of Pediatrics and Neurology at Hackensack Meridian School of Medicine and Assistant Professor of Pediatrics at Rutgers University and Mount Sinai School of Medicine.
Dr. Segal is on the boards of several epilepsy-focused nonprofit organizations, including New Jersey’s Family Resource Network and the Epilepsy Foundation of Northeastern New York.
Elizabeth Ann Curko Kera, PhD, Neuropsychologist
Dr. Elizabeth Kera practices neuropsychology in the Department of Neurology and Neuroscience Institute of Hackensack University Medical Center. She is board-certified in Clinical Neuropsychology through the American Board of Professional Psychology (ABPP). Dr. Kera obtained her BA in Psychology as an Honors Scholar at New York University in 2000. In 2006, she completed her PhD in neuropsychology at the Graduate School and University Center of the City University of New York. She completed her internship in neuropsychology at Long Island Jewish Medical Center, and a two-year postdoctoral fellowship in neuropsychology at Children’s Specialized Hospital of New Jersey. Dr. Kera has co-authored numerous publications and presented on a variety of topics in neuropsychology and is active in several neuropsychological organizations. She specializes in the neuropsychological assessment of both pediatric and adult populations, focusing on conditions such as multiple sclerosis, Parkinson’s disease, concussion, traumatic brain injury, epilepsy, and stroke. Combining her extensive expertise in neuropsychology, neuroscience, and developmental psychology, Dr. Kera partners with patients, their families, and other healthcare professionals to provide a comprehensive assessment of cognitive functioning, and to develop appropriate treatment and rehabilitation recommendations.
Brian Amorello, PhD, Counseling Psychologist
Dr. Brian Amorello is a licensed Counseling Psychologist in the Department of Neurology and the Neuroscience Institute of Hackensack University Medical Center. He earned a BA in psychology from Montclair State University and an MA in Counseling at Seton Hall University, then became a Licensed Professional Counselor. In 2016, he completed a PhD in Counseling Psychology at Seton Hall University, including an internship accredited by the American Psychological Association at the University at Buffalo and a fellowship at the University of the Sciences Student Health and Counseling in Philadelphia. He serves on the faculty of the Department of Neurology at Hackensack Meridian School of Medicine at Seton Hall University. Dr. Amorello has presented his research at state and national conferences, and has chaired various psychological organizations around New Jersey. He specializes in working with individuals across the life span with a variety of mental health concerns, including depression and anxiety. His work is grounded in cognitive behavioral therapy (CBT) and mindfulness, and he works with patients and their families to develop treatment goals that help patients optimize their quality of life, emotional wellbeing, and health behavior. Dr. Amorello is excited to work with the team at the Neuroscience Institute, because patients’ physical and psychological needs are best served by a collaborative interprofessional approach. He believes that strong relationships with patients, families, and healthcare professionals provide individuals with the opportunity to achieve both physical and mental health.