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may eventually be outgrown, Akron Children's specialists say it is important to know when it is time to pursue other options. "Over the last few years, many studies have shown that once you fail at two medications — and some say even one — you should look at other ways of treating epilepsy," says Dr. Hudgins. The carefully controlled, high-fat ketogenic diet, which changes the body's internal environment, is one option for some children. Epilepsy Program staff determine which patients are candidates for this approach and help families implement it. For other children, the best option may be surgery. Finding the Source of Seizures Akron Children's uses a variety of tools and technologies to evaluate surgical candidates. The hospital's new epilepsy monitoring unit is a controlled environ- ment where diagnostic information can be gathered. The unit has four rooms which are specially wired with EEG equipment and ceiling-mounted video cameras. By observing patients in the unit for up to two weeks, the team can record seizures as they happen to obtain vital information about how and where they occur in the brain. When necessary, medication doses may be lowered to help trigger a seizure in the safe environment of the unit. The suspected location of a seizure disorder may be confirmed or refined through neuropsychological testing. Using a battery of specially designed assessment tools, Dr. Stanford looks for a lateralized pattern of deficits in a child's brain. "I try to determine if there is a greater disruption in those abilities presumed to be mediated by various areas of the brain that would fit with where we believe the seizures are," she says. "Our testing will reveal a pattern, then we look to see if it is consistent with what we found from neuroradiology, EEG/video monitoring, MRI, etc. We want to make sure the child's functional output is consistent with what we have learned from an anatomical point of view." In some cases, an advanced method called brain mapping may be used to provide an even more precise seizure location. During the surgical procedure, hundreds of EEG electrodes imbedded on a thin plastic grid are implanted directly on the surface of the brain. Later, when a seizure occurs in the epilepsy monitoring unit, its location in the brain can be determined within millimeters. Akron Children's has performed brain mapping on children as young as 3 months old. "This type of mapping gives the surgeon a very detailed picture of the part of the brain that we need to remove (the part causing the seizures) and what we want to stay away from (all the normal brain that's providing normal function for the patient)," says Dr. Holder. "With mapping, our patients have a very high success rate for being seizure free because we remove everything causing the seizures. And, we have a very low complication rate because we leave all the normal brain in place." Surgery and Beyond Armed with the information provided by video/EEG monitoring, neuropsy- chological testing and brain mapping, Lisa Stanford, PhD, ABPP, is the director of the Division of Neurobehavioral Health. A board-certified neuropsychologist, she evaluates the cognitive, behavioral, social, adaptive and academic functioning of pediatric epilepsy patients.