Clinical Programs and Services

Clinical Drug Trials

The Pediatric Epilepsy Center conducts clinical trials of newer anti-epileptic drugs and other newer therapies for epilepsy in children. All ongoing studies may not be listed on this webpage. Please call 314-454-4089 for more information.

Epilepsy/Clinical Neurophysiology Fellowships

For physicians, we offer ACGME-approved 2-year fellowship in Pediatric Epilepsy and Clinical Neurophysiology. More information.

Epilepsy Clinics

Epilepsy Education for Patients and Family / Intraspectable Epilepsy Program / New Anti-Epileptic Drugs / New-Onset Seizure Clinic

Outpatient epilepsy clinics operate every day of the year, except holidays and weekends. Six board-certified pediatric neurologists with specialized training in epilepsy and two epilepsy nurse practitioners see exclusively seizure patients. Patients range from people who have experienced their first seizure, patients with uncomplicated epilepsy who are well-controlled on medication, and patients with medically-intractable epilepsy.

New-Onset Seizure Clinic: Two epilepsy nurse practitioners run a special clinic for patients who have experienced their first seizure, with the primary goal of providing rapid and thorough evaluation and information to the patients and their family at this often frightening time. An initial diagnostic evaluation, including a complete history, physical examination, and usually an EEG, typically can be completed within one working day of referral. Extensive education about seizures is provided. For more information on the evaluation of a first seizure, see an article in the epilepsy information section.

Intractable Epilepsy Program: The pediatric epilepsy center receives referrals from throughout the United States and the world to see patients with difficult-to-control epilepsy. After a thorough evaluation, appropriate options for improving seizure control are discussed in detail with the patient and family, including new antiepileptic drugs, ketogenic diet, epilepsy surgery, and vagal nerve stimulator.

Epilepsy Surgery

The Pediatric Epilepsy Center offers a number of different surgical treatments for appropriate patients with intractable epilepsy. Candidate patients undergo a thorough evaluation often involving a number of diagnostic tests, such as video-EEG monitoring, MRI scan, PET scan, SPECT scan, and neuropsychological testing, to determine the patient’s appropriateness for surgery and the best possible surgical approach (For more information on the presurgical evaluation, see an article in the epilepsy information section.)

The following are surgical techniques performed at the Pediatric Epilepsy Center by experienced neurosurgeons:

Temporal Lobectomy: Surgical resection of a portion of the temporal lobe for patients with intractable temporal lobe epilepsy.

Amygdalohippocampectomy: A more selective surgical resection of the temporal lobe than conventional temporal lobectomy for patients with intractable mesial temporal lobe epilepsy. For more information on amygdalohippocampectomy, go to an article in the epilepsy information section.

Extra-temporal Lobectomy: Focal surgical resection of a portion of the brain outside of the temporal lobe, such as frontal, parietal or occipital lobe, for patients with intractable epilepsy originating in these other lobes.

Hemispherectomy: Surgical resection/isolation of one hemisphere of the brain, appropriate only for very selected patients.

Corpus Callostomy: Surgical cutting of the corpus callosum, the fiber bundle that connects the two hemispheres of the brain, appropriate only for very selected patients.

Gamma Knife Surgery: A novel non-invasive surgical technique for resection of epileptic foci, especially appropriate for patients with other complicated medical problems.

Vagal Nerve Stimulator: Surgical insertion of an electrical stimulator to the vagus nerve, a recent novel treatment for intractable epilepsy. For more information on vagal nerve stimulator, go to an article in the epilepsy information section.

Ketogenic Diet

A team of physicians, nurses, and dieticians educates patients and families about this often effective dietary treatment for patients with intractable epilepsy. Appropriate patients and their families interested in the ketogenic diet are then guided through the process of initiating, maintaining and monitoring patients on the diet. For more information on the ketogenic diet, go to an article in the epilepsy information section.

Electroencephalography (EEG), Ambulatory EEG Monitoring, Epilepsy Monitoring Unit and Video EEG Monitoring

The Pediatric Epilepsy Center provides a range of services in electroencephalography (EEG). The outpatient EEG laboratory operates every day of the year, except weekends and holidays. Overnight ambulatory EEG monitoring can be set up, allowing EEG to be monitored at home. Video-EEG monitoring is performed in five inpatient beds in the Epilepsy Monitoring Unit of St. Louis Children’s Hospital. For more information on EEG, go to an article in the epilepsy information section.

Neuroimaging, MRI, Functional MRI, Ictal SPECT, MR Spectroscopy and PET Scan

The Pediatric Epilepsy Center, in conjunction with the Department of Radiology of Washington University School of Medicine and the Mallinckrodt Institute of Radiology, offers a range of cutting-edge neuroimaging techniques to evaluate patients with epilepsy:

Magnetic Resonance Imaging (MRI): MRI creates a high-resolution picture of the brain anatomy and may provide information about the cause of a patient’s seizures.

Functional MRI: Functional MRI allows localization of important brain functions, such as language or motor activity, and is used primarily during evaluation of patients for epilepsy surgery.

Positron Emission Tomography (PET): PET provides a map of the metabolic activity of the brain and is used primarily to help localize the seizure focus during evaluation of patients for epilepsy surgery.

Single Photon Emission Computed Tomography (SPECT): SPECT provides a map of blood flow to the brain before and during a seizure and is used primarily to help localize the seizure focus during evaluation of patients for epilepsy surgery.

Magnetic Resonance Spectroscopy (MRS): MRS measures specific neurochemicals in the brain and is used rarely to provide information about the cause of a patient’s seizures.

Neuropsychological Assessment

A staff of neuropsychologists work with neurologists to provide complete assessment of patients’ developmental, educational, and psychological issues. Formal neuropsychological testing is performed by staff, specially trained in working with children. For more information on neuropsychological assessment, go to an article in the epilepsy information section.