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Epilepsy treatment options for children at the Medical Center – University of Freiburg

When a child is a patient his/her parents want to use all possible diagnostic and therapeutic opportunities. Only few epilepsy centers in the world offer such a wide range of diagnostic methods and treatment possibilities as offered at the Medical Center – University of Freiburg.

Department of neuropediatrics and muscle disorders, Center for pediatrics

As a rule, children and adolescents who have incident cases of epilepsy are primarily examined and receive treatment in the Center for pediatrics of the Medical Center – University of Freiburg. It is performed under auspices of children neurologists (=neuropediatricians) in close contact with neuroradiologists, metabolic activity specialists and in this particular case with neurosurgeons. Alongside with targeted anamnesis and clinical examination it is offered to use EEG leads in the sleep and vigil state. In special cases the examination can be performed over a span of more than 24 hours. Depending on the results of clinical examination and EEG the metabolism analysis is made as well as the genetic research and the magnetic resonance imaging. The drug therapy often starts with the short-term hospital stay and then it continues in a specialized outpatient department during a long period of time. Those who have severe seizures can have a longer-term hospital treatment if it is necessary.  One of the parents can stay with a child in the department during the day, and if the child is small or stirring the parent has an opportunity to be with him/her also at night. In case of complex diagnostics or therapies the close collaboration with the Epilepsy center of the Neurocenter starts at the early stage.

Along with the experienced doctors there is a team of psychologists, medical pedagogics specialists, therapists and community workers in the Center for Social Pediatrics which is a part of the Center for pediatrics. They all work in cooperation with each other at suspicion on the violations in the mental development or in case if they exist, if there are child guidance problems as well as if the assistance in the mental perception of disease is required. The workers of the center and the qualified doctors regularly offer training workshops on the course of disease and illness therapy within the framework of the national German program, called Famoses-Programm.

Epilepsy center of the Medical Center – University of Freiburg

Highly professional interdisciplinary team of children neurologists, neuropsychologists, neuroradiologists, neurosurgeons as well as technical and operating personnel works in the center. For many years they deal with the examination and therapy of epilepsies which hardly answer the medical treatment. The diagnostics and treatment of children and adolescents is performed in cooperation with the Department of Neuropediatrics of Center for Pediatrics and other social and pediatric centers.

The Neurocenter in Freiburg is equipped with the long-term video-EEG-monitoring which has altogether 6 places with EEG leads (256 EEG channels and synchronic digital video recording) located in 4 special hospital wards. Two hospital wards are equipped as family wards or baby care wards where the accompanying person can constantly stay.  Neuropsychological diagnostics and psychological development examination, high-resolution structural MRI and functional visualization diagnostics (fMRI), radioisotope scanning (PET, SPECT) and WADA-test are the following examinations which are made and coordinated in the inpatient department within the framework of profound diagnostics of epilepsy. If it is necessary, in case of drug-refractory epilepsy there is a possibility to cure the patients by means of new anticonvulsive medications or other innovative methods under the frame of participation in the clinical research.

The peculiarity of the Epilepsy Center in Freiburg is the close collaboration with the Department of Stereotactic and Functional Neurosurgery.  Owing to this within more than 10 years there is an opportunity to use invasive EEG leads and to define the motor cortex by means of electrical stimulation before the operational intervention. The Neurocenter of the Medical Center – University of Freiburg offers operative therapy as well as preoperative and postoperative supervision of children and adolescents who went through the surgical procedure; the infant care (children up to 5 years) is given in the Intensive care unit of the Center for Pediatrics. In case if the surgical treatment of epilepsy is inadvisable or undesirable other methods of treatment, for instance, implantation of Vagus Nerve Stimulator (VNS), are considered. These opportunities are also given to the young patients and their families in case if the epilepsy is rebellious.

Approximately 80-100 operative interventions aimed at epilepsy treatment are made annually, whereof 20-25 surgeries are performed among children and adolescents.