UPMC Children’s Epilepsy Center Expands Access Through Telemedicine, Second Opinion Consultations, and International Outreach

The Epilepsy Center at UPMC Children’s Hospital of Pittsburgh is a Level 4 program and the only pediatric center in the region offering comprehensive evaluation, medical, and surgical treatments for children and adolescents with epilepsy.

Through a telemedicine-based second opinion consultation service and a growing international outreach effort, the UPMC Children’s Pediatric Epilepsy Surgery Program is extending its reach for patients and their families. Leading these efforts are William Welch, MD, director of the Pediatric Epilepsy Surgery Program, and Ruba Al-Ramadhani, MD, associate director of the Pediatric Epilepsy Surgery Program. Working alongside Dr. Welch and Dr. Al-Ramadhani on second opinion consultations is Taylor Abel, MD, chief of pediatric neurosurgery and surgical director of UPMC Children’s Pediatric Epilepsy Surgery Program.

“Telemedicine has made it possible for us to be a resource for families and clinicians wherever a patient is located,” Dr. Welch says. “For a family who can’t easily get to Pittsburgh, or a clinician looking for a second set of eyes on a complex case, geography is not a barrier to discussion and consultation.”

Dr. Welch and Dr. Al-Ramadhani are both surgical epileptologists whose clinical focus is epilepsy surgery evaluation and treatment. Along with Dr. Abel, they have built a second opinion consultation model that gives referring clinicians and families access to the full depth of the center’s surgical and nonsurgical expertise, without requiring an in-person visit to initiate that conversation.

“Families come to us wanting to understand all of their options,” Dr. Al-Ramadhani says. “Because our center can offer every treatment approach available for pediatric epilepsy, the consultation becomes a broader conversation about what is possible for their child.”

Second Opinion Consultations

Children with epilepsy whose seizures remain suboptimally controlled after trying two or more antiseizure medications are candidates for evaluation at a Level 4 epilepsy center. This evaluation allows for a comprehensive assessment and discussion of surgical or other options that may not be uniformly available in every practice setting or region inside and out of the United States.

For families already working with another epilepsy program, the UPMC Children’s Epilepsy Center provides second opinion consultations for patients whose families want additional input on a current treatment plan or who want to understand whether other options exist that they may not have considered before.

Because access to high-volume, Level 4 pediatric epilepsy centers is not uniform, the telemedicine consultation model reduces those obstacles, giving families and referring clinicians a direct line to the center without requiring an initial in-person visit.

Those consultations serve two distinct purposes. In some cases, the team’s assessment confirms that the plan in place for a patient is appropriate, giving the family confidence to move forward with care wherever they happen to reside. For other patients, the evaluation may identify options that had not yet been part of the discussion.

“We’ve done second opinions where our role was really to reassure the family that they were in good hands and that we agreed with what was being proposed at their home institution,” Dr. Welch says. “And we’ve done others where we had something different to offer. Both outcomes are valuable for patients and their families.”

How the Second Opinion Consultation Process Works

Prior to meeting with the family, Drs. Welch, Al-Ramadhani, and Abel review all available records, including EEG reports, MRI studies, prior clinic notes, and medication history, to develop a clear picture of what has been done and what options may be available for the patient. Kiersten Reznik, PA-C, the center’s physician assistant, with a breadth of experience in managing intractable epilepsy and epilepsy surgery patients, contacts patients and families for an introductory phone call and discussion of their most pressing concerns and questions.

“By the time we sit down with a family virtually, we already have a working sense of where they are in their epilepsy journey and what may or may not have been considered,” Dr. Al-Ramadhani says.

If a family decides to proceed with a full evaluation at UPMC Children’s, complete phase one testing is conducted in the EMU and follows the same protocol used for any patient with intractable epilepsy undergoing pre-surgical evaluation. This includes prolonged EEG monitoring with seizure capture, epilepsy protocol MRI, PET and SPECT imaging, and consultations with neuropsychology, behavioral health, child life, and social work. Magnetoencephalography (MEG) and navigated transcranial magnetic stimulation (nTMS) are also available for certain patients.

“We review records extensively before a family comes in, but we always make clear that the data obtained here at our center may change our thinking,” Dr. Welch says. “Getting everything into our own system is how we make sure our entire team is working from the most current and uniform picture of what’s going on with the patient.”

For families traveling from a distance, the UPMC Children’s Epilepsy Center works to consolidate all testing into a single admission, which is typically estimated to take one to two weeks. The center’s dedicated epilepsy social worker, Reghan Lieberman, MSW, LSW, can assist families with information and access to local resources while they are in Pittsburgh. The international services team at UPMC Children’s provides logistical support, including housing assistance and interpretation services, for families coming from outside the country for evaluation.

International Outreach and Collaboration

The UPMC Children’s Epilepsy Center’s outreach goes beyond the broader United States or North America. Families and clinicians in England, Israel, Puerto Rico, and across the Middle East have contacted the center for second opinions and consultations.

“We have had families reach out from all around the world,” Dr. Al-Ramadhani says. “Telemedicine means we can engage with families and colleagues globally even when an in-person visit isn’t feasible, and the international services team has been an important collaborator in making these outreach efforts feasible for families in other countries.”

Dr. Al-Ramadhani, who speaks Arabic, has led a focused effort to build clinical relationships in the Middle East with the UPMC Children’s Epilepsy Center. Through engagement with the International League Against Epilepsy (ILAE) and its Egyptian chapter, Dr. Al-Ramadhani and colleagues now hold quarterly virtual case conferences with neurology colleagues in Egypt, reviewing complex cases together and offering guidance on diagnostic and treatment approaches.

The team also has research collaborations with ILAE colleagues in the region. Dr. Al-Ramadhani has additionally represented the UPMC Children’s Epilepsy Center at Middle Eastern embassies in Washington, D.C., presenting on capabilities and outcomes.

“For clinicians with a patient who has complex or refractory epilepsy, we want them to know we are here and easy to work with,” Dr. Welch says. “Whether that starts with a virtual second opinion or a direct referral for evaluation, the process is designed to be straightforward and patient-centric.”

Patient Referrals

To refer a patient or request a second opinion consultation, contact the UPMC Children’s Hospital of Pittsburgh Epilepsy Center at 412-692-6928.