When Dr. James W. Wheless, came on board to Le Bonheur Children’s Medical Center as Director of the Neuroscience Institute and of the LeBonheur Comprehensive Epilepsy Program , in May 2005, he came on with several goals, but the immediate one was to raise the epilepsy program from a Level I to a Level IV national epilepsy program for children.

“This was a tremendous opportunity for me to get involved on the ground floor and be able to help an incredibly underserved population and make a huge impact on the care of children with epilepsy in the greater mid-south. My goal was to create a hospital environment where those children with difficult-to-treat epilepsy and their families could go to seek care that would offer them one stop shopping. Physicians working at Le Bonheur would be able to offer them all the diagnostic tests that were available anywhere in the world, formulate a treatment plan, and then be able to provide a choice of treatments from all those currently in existence worldwide,” said Wheless.

Le Bonheur Neurology Clinic: The Evolution

Before the upgrade and the expansion of the inpatient Epilepsy Monitoring Unit (EMU), about one to two pediatric neurology patients were admitted each week. However, since the expansion and the upgrade of the EMU, there has been a significant rise in the number of pediatric patients being evaluated and treated for neurological disorders including epilepsy. “Currently, we have 4 inpatient beds in our epilepsy monitoring unit. However, we are expanding to 7 beds in April of this year,” said Wheless. “This will make us one of the larger pediatric EMUs in the country.”

In addition, Wheless is in the process of implementing a clinical research program, as well as a residency program, to train future pediatric neurologists. There is currently no training program for physicians interested in the treatment of children with neurologic problems in the University of Tennessee Health Science Center. He hopes to have the training program, based at Le Bonheur, certified by this fall, with residents starting soon after. This is a three-year training program, and applicants will have completed either two or three years of pediatric training prior to entry.

Dr. Vickie R. Brewer, Chief of Neuropsychology, Neuroscience Center, Le Bonheur Children's Medical Center, and Clinical Assistant Professor of Pediatrics and Neurology University of Tennessee Health Science Center, has been an integral part of Le Bonheur since 1996. Since the opening of the clinic, Brewer has seen a dramatic difference in the level of comprehensive care being provided. “I have truly seen our comprehensive epilepsy center evolve significantly since Dr. Wheless and the rest of his team joined us. Now, we have new technology in imaging, very clear and defined protocols in the evaluation, diagnosis and treatment of epilepsy, and a multidisciplinary approach to caring for pediatric patients with epilepsy,” she said.

Brewer believes the multidisciplinary approach to care of epilepsy patients is essential to elevating a comprehensive epilepsy center from a Level I to a Level IV. “We have a very dynamic team of people all working together to provide care for our pediatric epilepsy patients. In fact, on all cases there is a neurosurgeon, neuropsychologist and epileptologist giving input and it is truly an integrated team working to do what is best for the child.”

She also believes providing future generations with the opportunity for practical and clinical training at the Neuroscience Center is another important element indicative of the clinic’s evolution. “There are very few neuropsychologists in the field in general and we have just awarded our very first fellow a 2-year pediatric Neuropsychology Fellowship with an emphasis on training in epilepsy and general neuroscience. I am very excited about the opportunity to be involved in this training process and excited about the direction Dr. Wheless is moving us in terms of research, training, diagnosis, and treatment of children with epilepsy.”

What is a Level IV National Epilepsy Program?

According to The National Association of Epilepsy Center 1,a specialized epilepsy center provides comprehensive diagnostic and treatment services primarily or exclusively to people with intractable epilepsy. Such a program is staffed by physicians, psychologists, nurses, technologists, and other personnel with special training and experience in the treatment of epilepsy. It includes facilities and equipment necessary to provide appropriate care or has well-established patterns of access to necessary facilities.

Epilepsy care can be divided into four levels. First-level care is provided by the primary care physician. Second-level care is provided by a general neurologist. Third-or fourth- level care is geared towards patients with persistent seizures who have not responded to standard treatment. The fourth-level epilepsy center serves as a regional or national referral facility and provides more complex forms of intensive neurodiagnostic monitoring, as well as more extensive medical, neuropsychological, and psychosocial treatment. They also offer a complete diagnostic evaluation for epilepsy surgery, including intracranial electrodes, and provide a broad range of surgical procedures for epilepsy.

Words of Wisdom for Clinicians

Having been the director of a Level IV comprehensive epilepsy center prior to taking the position as Director at Le Bonheur, Wheless believes experience is the best teacher. “I really think it is crucial for clinicians interested in developing a Level IV facility to understand how one operates, and the best way to learn how one operates is to spend time in an existing facility,” he said. Furthermore, Wheless stresses the importance of having trained personnel in place. “One advantage I had in elevating the epilepsy program from a Level I to a Level IV was that I already knew what my resources were, including the individuals with expertise in the field of epilepsy. Therefore, it was much easier to assimilate individual members into a comprehensive team.” He encourages clinicians to contact the National Association of Epilepsy Centers for in-depth information about starting a Level IV center.

Continuing Challenges

While Wheless and the epilepsy team at Le Bonheur Children’s Medical Center are accomplishing extraordinary feats in treating children with the most difficult forms of epilepsy in Memphis and the surrounding areas, the burden of serving as the beacon for epilepsy outreach and information falls solely ontheir shoulders. “Unfortunately, we do not have an Epilepsy Foundation affiliate in Memphis, Tennessee and so there is a tremendous need for a community-based program that provides people with a place to go for support and information,” Wheless said. He is currently looking into how to go about getting a local Epilepsy Foundation chapter in the Memphis area.

For more information about Le Bonheur Comprehensive Epilepsy Center please go to:www.lebonheur.org/Comprehensive_Epilepsy_Center.325.0.html

References

1. Walczak, T.S. Report of the National Association of Epilepsy Centers: Guidelines for Essential Services, Personnel, and Facilities in Specialized Epilepsy Centers in the United States. Epilepsia 2001;42(6): 804-814.