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The antiepileptic drug felbamate has demonstrated efficacy against a variety of seizure types in the pediatric population, particularly seizures associated with Lennox-Gastaut syndrome. Postmarketing experience, however, revealed serious idiosyncratic adverse effects not observed during clinical trials, including aplastic anemia and liver failure. As a result, many physicians have been hesitant to prescribe felbamate. This retrospective study evaluated the efficacy of felbamate in a pediatric population with intractable epilepsy. Of 38 patients, 22 had Lennox-Gastaut syndrome (58%); 6 had myoclonic-astatic epilepsy of Doose (16%); 5 had symptomatic generalized epilepsy, not otherwise specified (13%); and 5 had symptomatic localization-related epilepsy (13%). Most patients had multiple seizure types and had been tried on a variety of antiepileptic medications. With felbamate treatment, 6 patients (16%) became seizure free, including 4 of the 6 patients with myoclonic-astatic epilepsy of Doose; 24 patients (63%) had a greater than 50% reduction in seizure frequency. In this population felbamate appeared to be safe, with minimal adverse effects. The study is limited by the small number of patients and by its retrospective nature, but nonetheless adds to the evidence that felbamate is an important antiepileptic drug for medically refractory epilepsy in children and is well tolerated with few adverse effects.

The purpose of this project was to develop a system that would allow ambulatory pediatric nurses to describe their practice and to develop in their role as nurses. Patricia Benner's novice to expert philosophy has been used to describe the practice of nurses in many specialties; however, it has not been applied to ambulatory pediatric practice. A group of nurses at Children's Hospital of Wisconsin used Benner's philosophy to generate behaviors that evolved from the novice to the expert within the domains of nursing practice outlined in the ambulatory nurse job description. This tool has been implemented as part of the performance review process and is given to new nurses on orientation as a framework for nurses' professional development.

A consecutive, retrospective analysis of seizure control and quality of life was performed among 83 pediatric patients undergoing epilepsy surgery at Children's Hospital of Wisconsin. Seizure outcomes were generally favorable, with 68.7% class I outcomes; class II, 12%; and class III, 19.3%. Seizure freedom was highest among temporal lobectomies (84.2%) and hemispherectomies (76.2%). Outcomes among hemispherectomies were substantially superior to those of multilobar resections. Cortical dysplasia was associated with lower seizure freedom, at 57.5%. Among age groups, seizure-free outcomes in infants were lowest, at 50%. The lower infant seizure-free rate was likely attributable to frequency of multilobar resections and type of pathology (cortical dysplasia). Quality-of-life measures generally paralleled seizure outcomes. These results indicate that epilepsy surgery in children with intractable epilepsy can result in significant improvements in seizure control, quality of life, and development. Anticipated type of surgery, presumed location of epileptogenic site, absence of a defined lesion on magnetic resonance imaging scan of the brain, and patient's age should not prevent surgical evaluations of children with intractable epilepsy.

The ketogenic diet is a multidisciplinary therapy that requires the dedicated support of physicians, nurses, dietitians, and social workers. A registered dietitian with pediatric experience is vital to the success of a ketogenic diet program, for this person is responsible for calculating, initiating, and fine-tuning the ketogenic diet. The dietitian must assure that nutritional needs are met during the course of diet therapy. The dietitian’s responsibilities include communicating medical concerns to medical team members and communicating regularly with the caregiver of the individual on the ketogenic diet. It is the responsibility of the epileptologist or neurologist and the nurse clinician to provide medical supervision of the ketogenic diet.