Wellness, revolutionized. - Children's Hospital Central California

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A stimulating alternative. Trips to the Emergency Department (ED) for partial-onset seizures can be a way of life for kids with epilepsy. If the child is not a candidate for epilepsy surgery and has tried multiple antiepileptic medications with little relief, the vagus nerve stimulator (VNS) can be an effective option. “VNS is not a cure for seizures, but it can mean fewer visits to the ED and fewer stays in the Pediatric Intensive Care Unit,” said Dr. Steven Ehrreich, Children’s medical director of neurology. Since approximately one-third of patients taking medication for epilepsy continue to have seizures, VNS can provide a valuable secondary form of treatment. VNS does not eliminate the need for medicine, but can help reduce the risk of complications from severe or repeated seizures. Similar to a cardiac pacemaker, the VNS is a silver-dollar-sized device surgically implanted under the skin near the collarbone. A wire, or lead, under the skin connects the device to the vagus nerve in the neck. The patient’s neurologist programs the device to produce weak electrical signals that travel along the vagus nerve to the brain at regular intervals. These signals help prevent electrical bursts in the brain that cause seizures. The lithium batteries need to be changed about every five to seven years. If a seizure feels like it’s about to start or is already in progress, the patient simply uses a handheld magnet to trigger the device. “The quality of the device keeps getting better,” said Dr. Michael Dunham, Children’s medical director of otolaryngology, who performs the majority of VNS implants at Children’s. “They’re smaller, easier to program, and have a longer battery life.” Children’s has one of the highest case volumes in the state, but before turning to VNS as an option, caregivers collaborate to ensure the patient is a good fit. “We’ve seen patients tremendously helped by VNS, but the key is to select them properly,” said Dr. Gary Magram, Children’s medical director of neurosurgery. Most patients experience fewer and less severe seizures after the implant, with the median reduction in seizure frequency about 50 percent. Video Nasoendoscopy. Video nasoendoscopy (VNE) is a procedure frequently used to assess speech in young children, including those with a cleft palate. Utilizing an endoscope, the VNE procedure allows an otolaryngologist and speech pathologist to look at the soft palate and the back of the throat as the patient speaks. A camera attached to the eyepiece of the endoscope records the test. “The video nasoendoscopy provides more precise results,” said Children’s otolaryngologist Dr. Jairo Torres. The otolaryngologist, speech pathologist, and plastic surgeon review the recording and discuss the case together. The results, coupled with those of a nasometry test – measuring the amount of air coming out of the nose and mouth – help determine the most appropriate intervention. “It’s a very interactive process,” said Dr. Peter Witt, Children’s medical director of plastic surgery. “We get consensus on the best course of treatment for the patient.” Dr. Witt specializes in cleft lip and palate repair and subsequent speech issues. Cleft lip and palate is the most common birth defect in the U.S., affecting one in every 600 newborns. “There is tremendous stigma associated with this condition,” said Dr. Witt. “Those affected don’t speak or swallow properly, and they often have impaired hearing and respiratory and nasal problems, among other things.” Team care, such as that demonstrated with the VNE test, has shown to be effective in addressing such complex cases and improving long-term outcomes for these patients. (Continued on page 21) 20 RETURN TO TABLE OF CONTENTS
RETURN TO TABLE OF CONTENTS 21 Dr. Magram has the vision and skill to develop better and more affordable shunts for patients here and around the world. That’s worth investing in. (Continued from page 20) Improving Treatment of Hydrocephalus. Dr. Gary Magram, Children’s medical director of neurosurgery, works to improve the treatment of hydrocephalus by developing better devices and instruments. With more than 20 years’ surgical experience, Dr. Magram is an expert on shunt design, holding several device patents. But he wants to do more, and a grateful patient family has decided to help. Scott and Debbie Amey of Virginia donated $100,000 to provide seed money for the <strong>Hospital</strong>’s neurosurgery fund. They say their daughter, Kara, now 17, is alive and going to college next year because of Dr. Magram’s expertise. Dr. Magram treated Kara on the East Coast before coming to Children’s. “He saved my life,” agreed Kara. When Kara was 10 years old, Dr. Magram diagnosed and removed a brain tumor. Weeks later she acquired hydrocephalus, a potentially life-threatening accumulation of fluid around the brain that affects about one in every 500 children. Dr. Magram surgically inserted a ventricular shunt system to relieve the pressure. Appreciative of the funding, Dr. Magram has big plans. With project planning already underway, he identified and contacted companies to work with him on developing minimally invasive endoscopes specifically designed for neurosurgery; shunt components such as connectors; and a prototype for a more efficient shunt. Next on his list - if additional funding becomes available - is to improve the shunts’ exterior drainage mechanism and alarms for patient safety. “These are projects I’ve dreamed about doing but didn’t have the money,” said Dr. Magram. All donations to the neurosurgery fund directly benef it hyd rocepha lu s research and development. None of the funding is used for grant writing, physician salaries or overhead. “Dr. Magram has the vision and skill to develop better and more affordable shunts for patients here and around the world,” said Debbie. “That’s worth investing in.” Kara talks to Dr. Magram in her home hospital on the East Coast. Dr. Magram treats children and adolescents from across the United States.
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Wellness, revolutionized. - Children's Hospital Central California

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