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Epilepsy affects nearly half a million children each year in the United States, according to recent estimates from the Centers for Disease Control and Prevention. It’s one of the most common neurological disorders diagnosed in America and takes on different forms in different people. UChicago Medicine interviewed Chalongchai Phitsanuwong, MD, assistant professor of pediatrics and director of the child neurology residency training program at Comer Children’s Hospital, about how epilepsy patients are diagnosed and treated.
Q: How do you diagnose a child with epilepsy?
A: Looking at a patient’s clinical history and conducting a thorough neurological examination are fundamentally important to diagnosing kids with epilepsy. We also use certain diagnostic tools like electroencephalography (EEG) or brain magnetic resonance imaging (MRI). To determine the cause of certain complicated cases, we may need to collect fluid from a patient’s spine and analyze their blood and urine or obtain genetic testing.
Q: What are the treatment options for epilepsy patients?
A: UChicago Medicine offers comprehensive treatments of epilepsy. Some patients need anti-seizure medications, while others may not respond to medications alone. For those patients, who we identify as having drug-resistant epilepsy, we offer surgery, ketogenic diets and a neurostimulator device, which is a device that provides electrical stimulation to the brain through leads to prevent seizures. We also look at symptoms and disorders that frequently accompany epilepsy, like learning disabilities, developmental delays and attention deficit/hyperactivity disorder (ADHD). Our team uses a comprehensive approach and works closely with developmental behavior pediatricians, social workers and our colleagues in child psychiatry.
Q: What is a ketogenic diet?
A: Ketogenic diets are special medical diets specifically used as metabolic-based therapy for epilepsy. They incorporate high fat, moderate protein and low carbohydrate foods, which induce a metabolic state called ketosis (hence, "ketogenic"). Experts do not know for certain how the ketogenic diets work to stop seizures, but they do know they are proven to work. We believe the diet has multiple mechanisms, and to put it simply, it "strengthens" the nervous system against seizures.
Q: Who qualifies for ketogenic diets?
A: Traditionally, these diets are used in patients who have failed at least two anti-seizure medications and are not deemed good surgical candidates. Ketogenic diets can be used early in some circumstances depending on clinical necessity. Although the diets have relatively low side effects, I strongly caution everybody who would like to start on the diet that it needs to be done under close supervision of a ketogenic diet-trained dietitian and neurologist. Currently at UChicago, we have a multidisciplinary ketogenic diet program with an epilepsy specialist, ketogenic dietitian, nurse and social worker that offers the dietary treatment for both children and adults with epilepsy.
Q: Do you primarily see patients on their first visit, or are you often a resource for second opinions?
A: Both. I have many patients in my practice who came to me after having a new onset seizure and even more patients who were referred or came to see me as a second or third opinion, as there are not many pediatric epilepsy specialists.
Q: What distinguishes UChicago Medicine’s epilepsy treatment offerings from other hospitals?
A: We are one of few places in the state that can offer such a wide array of epilepsy treatments for children, including anti-seizure medications, ketogenic diets, neurostimulation and traditional or minimally invasive epilepsy surgery. We also have an experienced team of pediatric neurologists, epileptologists, neurosurgeons and dietitians. We also offer a wide variety of epilepsy diagnostic tools including EEG with long-term monitoring, high-resolution MRI, PET scan, functional MRI and genetic testing for epilepsy.
Pediatric neurologist and epileptologist Chalongchai Phitsanuwong, MD, specializes in the treatment of children with epilepsy, using medication and medical diets. He has unique expertise in ketogenic diets for the treatment of difficult-to-control seizures, particularly when epilepsy surgery is not deemed an option.Read Dr. Phitsanuwong's physician bio