Advanced diagnostic techniques and therapeutics for epilepsy, an innovative surgical approach to cleft lip and palate repair, and a clinic dedicated to developing new standards of spinal muscular atrophy care are some of the highlights of the Arkansas Children’s pediatric neurology and neurosurgery team.
As a National Association of Epilepsy Centers Level 4 Center, Arkansas Children’s Hospital provides the highest level of epilepsy management from a team that includes epileptologists, neurosurgeons, neuropsychologists, neuroscientists and more.
“We use the most advanced diagnostic technology available,” said Fred Perkins, M.D., pediatric neurologist at Arkansas Children’s Hospital and associate professor of Pediatrics in the Division of Neurology at the University of Arkansas for Medical Sciences. “Magnetoencephalography [MEG] and transcranial magnetic stimulation are good examples. Both are used for presurgical planning. These technologies allow us to better determine surgical approaches and thus maximize the effectiveness of treatment while minimizing risks and discomfort. In some cases, these tools make the difference between being able to offer surgery or not.”
After evaluating potential surgical candidates in a multidisciplinary conference, Arkansas Children's Hospital neurosurgeons can perform stereoelectroencephalography with robotic assistance to place electrodes in the brain, precisely pinpointing the tissue where seizures originate for potential resection. Certain patients may be candidates for implantation of a responsive neurostimulation device, which can detect pre-seizure electrical activity and stimulate the brain to prevent seizures.
"The future of epilepsy care demands participation in translational research," Dr. Perkins said. "Arkansas Children's participates in a number of pharmaceutical trials providing opportunities to offer some of the latest medication treatments. We're also pursuing investigator-led studies of advanced diagnostics, such as MEG, and the use of artificial intelligence."
Fellowship-trained craniomaxillofacial surgeon Sagar Mehta, M.D., director of the craniofacial program at Arkansas Children’s Hospital and assistant professor in the Department of Pediatric Plastic and Reconstructive Surgery at the University of Arkansas for Medical Sciences, specializes in the treatment of cleft lip and palate, hemifacial microsomia, and craniosynostosis. Performing more than 100 craniosynostosis repairs annually makes Arkansas Children’s Hospital a high-volume center for craniosynostosis.
Dr. Mehta has reduced the blood transfusion rates for these surgeries down to 11% from national averages of greater than 75% - while also lowering the number of patients who require ICU care after surgery. He and his team are working on novel techniques for nonopioid pain management post-surgically.
Dr. Mehta is helping to shape the future of craniomaxillofacial surgery by investigating better ways to assess intracranial pressure and how craniosynostosis repair might improve it using simple blood tests.
He and his team are also pushing the paradigms of cleft lip and palate surgery.
"Traditionally, patients' final bone grafting procedures occur around 7 to 10 years of age," Dr. Mehta said. "My team has tailored a technique that puts bone into the hard palate and cleft, and places bone graft around age 2 to 3. Our goal is for kids with cleft lip and palate to complete a significant portion of their surgeries before they have memories of the experience."
Dr. Mehta typically uses bone allografts rather than hip bone grafts for cleft lip and palate repair, at least as a first-line therapy.
"Taking hip bone grafts causes difficulty walking and pain at the harvest site," Dr. Mehta said. "It also increases the length of surgery. Studies have shown equal efficacy from bone allografts versus hip bone grafts, especially with the first surgery. We've streamlined the process and turned what was a painful procedure requiring admission for pain management into an outpatient surgery where patients go home the same day."
As the only pediatric hospital in the state providing treatment of spinal muscular atrophy (SMA), Arkansas Children’s Hospital is home to a multidisciplinary SMA clinic where patients undergo assessments with multiple specialists, including a neurologist, pulmonologist, orthopedic surgeon and rehabilitation specialist, every four to six months.
Several medications are now available to treat SMA, including injectable nusinersen, one-dose gene therapy onasemnogene abeparvovec-xioi and risdiplam, the first FDA-approved oral medication. These therapies have helped patients maintain and, in many cases, improve motor function, according to Kapil Arya, M.D., medical director of the SMA clinic and pediatric neurologist at Arkansas Children’s Hospital and associate professor of Pediatrics in the Division of Neurology at the University of Arkansas for Medical Sciences. A study site for some of these medications prior to their FDA approval, Arkansas Children’s is currently participating in several new SMA medication studies.
Arkansas Children’s is helping to standardize care for SMA as part of the Cure SMA Care Center Network.
"The Care Center Network was established to recognize centers that follow best practices of care, to gather data from these centers and, eventually, to establish guidelines of care for other centers that may not have the same types of resources that we have," Dr. Arya said. "Through the network, I'm working with SMA physicians in the U.S. and Europe to create guidelines that will, hopefully, be published in 2022."
In addition to SMA, Arkansas Children’s Hospital specializes in treating spasticity through a combined neurology/rehabilitation clinic.
"Ours is the only site in Arkansas that provides comprehensive care to children with spasticity," Dr. Arya said. "One of the therapies we offer is intrathecal baclofen therapy. We collaborate with neurosurgeons to install the pumps, and then we follow patients in the spasticity clinic and refill the pumps."
Our nationally renowned specialists provide expert care for children suffering from a wide range of neurological disorders, treating brain, nervous system and neuromuscular disorders.
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