Treatment Guide

Pediatric Epilepsy

CHOOSING YOUR CHILD’S EPILEPSY CARE One percent of children in the United States have some

Together, they provide leading-edge diagnos-

form of pediatric epilepsy. If your child is affected by this

tics, extensive medical and surgical treatment

condition, you want the best medical and/or surgical

programs, and access to experimental thera-

care available. Our experienced and dedicated team of

pies not widely available. Our team’s experi-

specialists within the Pediatric Section of Cleveland Clinic’s

ence and expertise has yielded some of the

Epilepsy Center is dedicated to meeting the unique needs

best seizure-free outcomes worldwide.

of children with epilepsy and can work with you and your family to find the best treatment plan for your child. Families from across the country and around the world come to Cleveland Clinic’s Epilepsy Center to receive the most advanced and specialized care. Our expert clinical team includes physicians who specialize in neurology,

USING THIS GUIDE

Please use this guide as a resource as you examine your treatment options. If your child has a poor health-related quality of life due to

neurosurgery, neuroradiology, nuclear medicine, psychology

continuing seizures, you have the right to ask

and psychiatry, as well as nurses and social workers.

questions and seek a second opinion.

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Pediatric Epilepsy Center

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WHAT IS EPILEPSY AND HOW DOES IT AFFECT CHILDREN?

Facts and Figures – 2014

Epilepsy in children is a chronic medical condition marked by

• 2,700+ pediatric patient visits

recurrent seizures (an event of altered brain function caused by

• 120+ pediatric surgeries • 560+ pediatric monitoring unit admissions • 9-bed pediatric EMU, operating 24/7 with

abnormal or excessive electrical discharges from brain cells). Epilepsy is one of the most common neurological disorders, affecting up to 1 percent of the U.S. population. More than 45,000 children ages 18 and younger are diagnosed with

the latest technology and all-digital video

epilepsy every year. Many children with epilepsy may outgrow

EEG equipment

their condition as they age, while others may require ongoing

• Pediatric epilepsy imaging • Advanced diagnostic capabilities • Cognitive and behavioral program

treatment if their epilepsy is chronic.

HOW IS EPILEPSY DIAGNOSED? Patients with epilepsy are evaluated to determine the type of seizures (epileptic vs. non-epileptic) they are having and their cause to determine the most effective treatment. An epilepsy diagnosis is based on your child’s medical history, including family history of seizures, associated medical conditions and current medications. Doctors also conduct a complete physical and neurological examination of higher mental functions, muscle strength, reflexes, eyesight, hearing and ability to detect various sensations to better understand the cause of seizures. The physician may ask the following questions: • At what age did seizures begin? • What circumstances surrounded the first seizure? • What factors seem to bring on seizures? • What is felt before, during and after seizures?

Our pediatric epilepsy team is dedicated to caring for patients with epilepsy and educating them about the condition. Helping patients and their families understand the

• How long do seizures last? • Has your child received any treatments for epilepsy? • If so, which medications have been prescribed and in what dosages?

disease is a very important part of our job.

• Was treatment effective?

We strive to provide the best and most

• Eyewitness accounts from family or friends who can

updated information because the more you

describe the seizures

know, the more your child will benefit.

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WHAT ARE THE DIFFERENT TYPES OF TESTING USED TO DIAGNOSE EPILEPSY? The most common diagnostic tests include: • Electroencephalogram (EEG), which records the brain’s electrical activity and gives useful information about the location and type of epileptic discharges • Imaging studies of the brain, such as high-resolution magnetic resonance imaging (MRI) • Neuropsychological testing to determine the impact of epilepsy on the child’s language function, memory, intelligence, attention span, organizational skills and mood • Blood and urine tests to measure blood cell counts, blood sugar and electrolyte levels; liver and kidney function tests; and additional blood and urine tests to look for metabolic or genetic diseases • Other brain scans, including positron emission tomography (PET), single photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) may be appropriate for children being considered for epiilepsy surgery

HOW IS EPILEPSY TREATED? For most children struggling with epilepsy, it is possible to stop the seizures altogether with standard medications. Seizure freedom is achieved in about 50 percent of patients treated with the first anti-epileptic medication. After failure of the first drug, the seizurefree rate drops to between only 11 and 15 percent when the patient is placed on another drug or uses a combination of two drugs. After two or more anti-epileptic medications fail, there is only a 5 percent to 10 percent chance that future medication trials will result in seizure freedom. Overall, between two-thirds and three-quarters of all patients will become seizure free. The remaining group of patients has epilepsy that is much harder to control. This type of epilepsy is called “medically refractory” or “intractable” epilepsy.

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FIRST AID FOR SEIZURES Learn to recognize common symptoms of seizures: • Staring and unresponsiveness • Confusion • Jerks and twitches • Wandering • Shaking or falling • Picking or lip smacking • Whole-body convulsions (grand mal seizure) First aid steps: Non-convulsive seizures

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WHAT IF MY CHILD DOES NOT RESPOND TO MEDICATION? Why some patients respond well to a certain medication and not to another is not fully understood. This is why it is important to precisely identify the exact type of seizure with video-EEG monitoring and to determine of the underlying cause of epilepsy when considering what treatment will be the most effective for your child. Children with refractory epilepsy may be considered for dietary treatment which can be considered as a safe and effective alternative therapy. Children may also be evaluated for epilepsy surgery.

• Watch the person carefully to recognize the seizure

WHAT IS THE KETOGENIC DIET AND HOW CAN IT HELP?

• Speak quietly and calmly to the person

An epilepsy treatment option for children whose seizures remain

• Explain to others what is happening

uncontrolled — even with medication — is the ketogenic diet: a

• Guide the person gently to a safe area away from

high-fat, optimal protein, low-carbohydrate regimen. The ketogenic

any danger such as water, machinery or fire • Don’t restrain the person or try to stop the movements • Stay with the person until he or she regains complete consciousness

diet is used when a child’s seizures have not been satisfactorily controlled with adequate trials of medications or when a child has experienced undesirable side effects from the various seizure drugs. When the ketogenic diet is not practical, alternatives include a low-carbohydrate diet program or a low-glycemic diet. If a child has surgically treatable epilepsy, surgery is the preferred treatment.

Additional first aid steps:

An important requirement for beginning the diet is a commitment

Grand mal (convulsive) seizure

from those who will be taking care of the child because the diet

• Time the seizure • Look for an “Epilepsy” or “Seizure Disorders” bracelet • Place the person on his or her side, away from hazardous objects • Don’t put anything in the person’s mouth • Remove eyeglasses and any tight objects around the person’s neck • Call 9-1-1 if the seizure lasts more than five minutes or results in injury • Stay with the person until help arrives

requires extra time and effort – especially in the early stages of treatment. To be successful, families must be committed and disciplined in sticking to the diet. At Cleveland Clinic, support is readily available from the “Keto Team,” which includes an epileptologist, registered dietitians and a registered nurse (ketogenic diet coordinator). To help safely and effectively implement the diet, our specialized team coordinates a comprehensive neurological and nutritional assessment. The team will assist in jump-starting the diet during your child’s hospital stay and monitor for any side effects. You will be given meal plans before you leave the hospital. Our ketogenic diet team is also available to answer any questions that you may have once you have returned home.

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WHEN IS EPILEPSY SURGERY CONSIDERED AND WHO IS A CANDIDATE? One-third of children with epilepsy have difficult-to-control seizures that negatively impact quality of life for both them and their family. Your child may be a candidate for pediatric epilepsy surgery if he or she fails to respond to trials of two appropriate anti-epileptic medications in adequate doses. While many factors must be considered in developing a child’s epilepsy management plan, surgical options are often effective in providing relief from epileptic seizures and, consequently, the impact on the child’s cognitive and motor development.

HOW ARE PATIENTS EVALUATED FOR SURGERY? At Cleveland Clinic, epilepsy surgery evaluation usually begins with an office consultation with one of our board-certified pediatric epileptologists. Our physicians conduct a detailed history and physical examination and review the results of any tests that were performed by your child’s local physicians. We gather information on all significant factors that may affect our selection of the most appropriate treatment approach for your child.

Cleveland Clinic’s Epilepsy Program was one of the first programs in the nation to introduce surgery as a treatment option for children with intractable epilepsy.

Working closely with your family, we develop a pre-surgical plan that may include: • Hospital admission to our PEMU, staffed 24/7 and equipped with leading-edge monitoring equipment. During your child’s PEMU stay, we review video-EEG in real time, conduct any additional testing needed, coordinate brain scans — under sedation if needed — and obtain consultation(s) from other Cleveland Clinic specialist(s). For families visiting from long distances, we coordinate a testing and treatment plan in advance whenever possible. • Customized care for children with Tuberous Sclerosis Complex (TSC) and Sturge-Weber syndrome (SWS), both of which can cause intractable epilepsy. Our multispecialty clinics for these conditions unite dedicated specialists from various disciplines to manage the complex needs of such children and consider the impact of epilepsy surgery on other organs and systems. • Access to specialists in the fields of child psychiatry, neuropsychology and social work, who help families cope with the behavioral, developmental, social and academic challenges that often accompany pediatric epilepsy.

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A Comprehensive Approach to Epilepsy Surgery Cleveland Clinic’s unique model of epilepsy care combines unparalleled staff expertise with leadingedge technology and interdisciplinary collaboration. Our team of pediatric epileptologists, epilepsy neurosurgeons, pediatric neuropsychologists, pediatric psychiatrists and pediatric social workers has some of the best outcomes in the nation — even in the most challenging cases. As a result, physicians and families from around the world seek our consultation for treatment of children who are in need of epilepsy surgery. Our newly remodeled inpatient Pediatric Epilepsy Monitoring Unit (PEMU) is conveniently located in Cleveland Clinic Children’s, with 24/7 access to intensive care services.

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• Connection to support services that link visiting families with parents of children who have undergone pediatric epilepsy surgery. The Pediatric Epilepsy Support Group offers families an opportunity to share their thoughts, emotions and experiences, pre- and post-surgery. These families return to Cleveland every other year for a support group reunion.

WHAT TESTS ARE NEEDED TO HELP DECIDE IF SURGERY IS RIGHT FOR MY CHILD? A pediatric epilepsy surgery evaluation includes appropriate imaging tests to uncover brain abnormalities and map seizure foci (the area of the brain where seizures originate). Imaging technologies are coordinated and interpreted by top imaging experts for pediatric patients during a single PEMU admission period, if needed. The complex data from these tests help parents understand the best treatment options for their child. Advanced imaging technologies that are often used at Cleveland Clinic include: • Brain MRI. Brain abnormalities can be subtle, requiring special MRI protocols, high-resolution techniques and qualified experts to interpret these studies. Our brain MRI facility is dedicated to children, with support from pediatric anesthesia specialists for younger or more apprehensive children, when needed. Our equipment also includes a high-strength 3-Tesla magnet to provide leading-edge imaging in complex cases.

Each year, more than 2,000 pediatric

• PET scan. Our high-resolution positron emission tomography

patients are seen in our outpatient clinics.

(PET) scanner also helps uncover epilepsy foci in the brain. PET

More than 600 children are monitored

scans are particularly helpful in children whose brain MRI failed

in our dedicated leading-edge Pediatric

to show a clear lesion. PET images are used together with brain

Epilepsy Monitoring Unit, and more than

MRI and other imaging modalities to accurately identify the

120 epilepsy surgeries are performed on

seizure focus.

pediatric patients.

• Ictal SPECT scan. When appropriate, single photon emission computerized tomography (SPECT) scans can help identify the seizure focus through a radio-tagged agent injected during the very early stage of a seizure. We post-process the SPECT studies using sophisticated computer techniques. This provides more accurate seizure focus localization by subtracting baseline injection images from the seizure injection images.

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• MEG. In 2008, Cleveland Clinic added magnetoencephalography (MEG) technology to our Epilepsy Center. An integrated

Cleveland Clinic’s Pediatric Epilepsy Program

group of physicians, physicists, neurophysiologists, biomedical

conducts more than 150 scans a year using

engineers and computer scientists use leading-edge protocols

magnetoencephalography (MEG), one of the

to map seizure focus while the child sleeps in a scanner, with

highest clinical volumes for this technology

a parent at the bedside, if necessary. MEG measures abnormal

in the world.

brain activity, often with better localization accuracy than EEG. With no injections, radioactivity or strong magnetic fields, MEG is safe for both children and adults and is entirely non-invasive and painless. The MEG lab performs more than 150 scans per year, one of the highest clinical volumes in the world. Our Epilepsy Center MEG specialists are specially trained to work with children and infants of all ages. • Functional MRI and DTI. Advanced techniques such as functional MRI (fMRI) and diffusion tensor imaging (DTI), can localize critical areas and map circuits in the brain to help develop a surgical strategy.

WHEN TEST RESULTS ARE IN, HOW IS THE DECISION WHETHER TO RECOMMEND SURGERY MADE? Each patient being considered for pediatric epilepsy surgery at Cleveland Clinic is fully reviewed by our team of experts during the Epilepsy Center’s weekly Patient Management Conference. The decision to pursue brain surgery as a treatment option for a child is exceedingly difficult and stressful for parents to make, so we take this possibility very seriously. During the conference, each case is reviewed by pediatric epileptologists, neurosurgeons, neuroradiologists, psychiatrists, neuropsychologists, social workers and other specialists. This team of professionals contemplates the risks and benefits of epilepsy surgery for the child. The Epilepsy Center experts offer a variety of perspectives and ultimately make final recommendations, which are then shared with the patient’s family. We take the time to explain the recommendations to families and make sure all of their questions are answered.

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WHAT ARE THE DIFFERENT TYPES OF EPILEPSY SURGERY PROCEDURES AVAILABLE? After presenting the group’s final recommendations to the child’s family and local physicians, the members of the Pediatric Epilepsy Program remain available for questions before any decision is carried out. Consultations with experienced neurosurgeons and additional patient evaluations are completed prior to surgery. If a family decides to pursue pediatric epilepsy surgery, a team of experts is assembled — including pediatric neurosurgeons, epileptologists, intensive care staff members and pediatric anesthesia specialists. Using the safest surgical approach is a high priority for our pediatric epilepsy surgery team, which has a proud history of minimizing the risk of surgical complications. Children are often well suited for epilepsy surgery since their brains are still developing and can heal more easily from surgery. The surgical approaches commonly used for pediatric epilepsy include: • Extratemporal lesionectomy. This resection approach is the most common pediatric epilepsy surgery. It removes isolated lesion(s) or region(s) in the brain identified as the primary focal point(s) of seizures. These may include tumors or congenital (present at birth) malformations of the cortex (outer layer of the brain) or blood vessels. • Hemispherectomy. This approach may be considered in rare instances where a child has severe and uncontrollable seizures coupled with weakness or paralysis of one side of the body. This condition typically results from damage to the brain caused by an underlying congenital or acquired disease. Hemispherectomy is a complex surgery, and children who need it are often young and sick. Several types of hemispherectomy may be considered: – Functional hemispherectomy involves removing a portion of the brain’s hemisphere. The remaining tissue and fibers that communicate with the remaining side are disconnected. – Anatomic hemispherectomy involves removing the entire half of the brain, including the frontal, parietal, temporal and occipital lobes. – Peri-insular hemispherotomy involves disconnecting certain fibers, interrupting the communications network of the affected brain hemisphere.

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When seizures arise from multiple brain areas, or from an area that is performs key functions (such as interpreting sounds or storing memories), surgical options may pose too high a risk to overall brain function. In these rare situations when surgery is not possible, vagus nerve stimulation or other non-resective approaches are available for some patients. In selected children, invasive monitoring with subdural electrodes (placed on the surface of the brain) and/or the stereotactical placement of depth electrodes (placed within the brain), may be done before the resection procedure to more accurately identify the seizure foci. These techniques help map highly functional areas of the brain. An innovative, minimally-invasive surgical procedure available from Cleveland Clinic’s Epilepsy Center is stereoelectroencephalography (SEEG), in which depth electrodes are strategically and accurately placed in targeted brain areas to map the seizure focus. The electrodes are placed through tiny holes in the skull without the need for a craniotomy, which usually requires removing a large area of skull bone.

HOW LONG DOES IT TAKE TO RECOVER FROM EPILEPSY SURGERY? Following epilepsy surgery at Cleveland Clinic, children are cared for by an expert team of physicians and nurses. Soon after recovering from anesthesia, children are observed in the Pediatric Intensive Care Unit (PICU) for one or two days, followed by another three to five days in the hospital. Most children are able to go home, returning in about 10 days for sutures to be removed. By two weeks after surgery, patients can stay awake most of the day. At six weeks, they usually are able to return to school or work for a full day. Some patients may have mild cognitive difficulties, but these improve and stabilize three to six months after surgery. Patients should continue taking their seizure medications after surgery.

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WHAT HELP IS AVAILABLE TO HELP CHILDREN RECOVER FROM EPILEPSY SURGERY? Cleveland Clinic Children’s Rehabilitation campus provides

The program offers a focused team approach from expert

post-surgical care and outpatient and inpatient rehabilitation.

physicians who deliver comprehensive, multidisciplinary

A dedicated team of pediatric specialists, including doctors,

medical and surgical care. These physicians discuss patient

nurses, rehabilitation specialists and psychosocial support staff

care, as needed, to provide the best treatment option.

works with the Epilepsy Center and each family to help

Through this program we will also advance our understanding

children reach their full potential. Pediatric therapists work

and treatment of Tuberous Sclerosis through collaborative

one-on-one with each child using the most advanced equip-

research, and provide an educational avenue to families

ment specially designed for children. Each child’s rehabilitation

with Tuberous Sclerosis.

needs are assessed and they may be offered options that will maximize their function by: • Providing a comprehensive multidisciplinary approach to their care immediately after epilepsy surgery

If you have a specific question regarding a patient or our TSC program, contact Ajay Gupta, MD, at 216.445.060 (toll-free 1.800.223.2273, ext. 50601) or by email at [email protected].

• Maximizing the benefits of rehabilitation following surgery • Coordinating an outpatient rehabilitation treatment plan after acute inpatient hospitalization The rehabilitation team coordinates care after transfer and maintains communication with all providers, including the family’s pediatrician. Case managers help transition the child’s support network back to the comfort of home and local medical facilities. This comprehensive and multidisciplinary approach draws on the resources of Cleveland Clinic Children’s, the Cleveland Clinic Epilepsy Center and the Cleveland Clinic Children’s Hospital for Rehabilitation.

Cleveland Clinic’s Tuberous Sclerosis Program Tuberous Sclerosis Complex (TSC) is a genetic condition with a spectrum of clinical expressions. It commonly presents with epilepsy, autism or developmental delay, and skin birthmarks in early childhood. Sometimes, during adolescent years, skin lesions resembling severe acne may be the presenting feature. Cleveland Clinic’s Tuberous Sclerosis Program is offered through the Epilepsy Center and provides comprehensive longitudinal medical and surgical care to patients and families with TSC.

Cleveland Clinic’s Sturge-Weber Program Sturge-Weber Syndrome (SWS) is a rare, non-genetic condition resulting from an abnormal development of blood vessels of the skin, eyes and brain. This neurological disorder causes seizures at birth, accompanied by a large port-wine stain birthmark on the forehead and upper eyelid of one side of the face. The birthmark can vary in color from light pink to deep purple and is caused by an overabundance of capillaries around the trigeminal nerve just beneath the surface of the face. At the Cleveland Clinic Epilepsy Center, we have established a multidisciplinary team of dedicated pediatric and adult epilepsy specialists, neurosurgeons, neuropsychologists, neuroradiologists, functional neuroimaging experts, cognitive and behavior experts, health psychologists and bioethicists to administer epilepsy care to SWS patients. If you have a specific question regarding a patient or our SWS program, contact Ajay Gupta, MD, at 216.445.0601 (toll-free at 1.800.223.2273, ext. 50601) or by email at [email protected].

Biennial Support Group Reunion Cleveland Clinic hosts a Biennial Reunion for Pediatric Epilepsy surgery patients reuniting hundreds of patients and family

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members across the U.S. with their caregivers. Parents

Pediatric Epilepsy Support Group is a way for families to

have the opportunity to meet other parents whose children

interact with the members of the support group, as well as

underwent epilepsy surgeries. The reunion also includes

with each other.

workshops on medications/medical issues; rehabilitation; psychosocial/school and learning issues. Break-out sessions give parents with a change to get their questions answered by an expert panel. Patients and their siblings enjoy supervised fun-filled activities with our team of volunteers. To learn more, visit clevelandclinic.org/epilepsysupport or email [email protected].

Pediatric Epilepsy Support Group (PESG)

Caring for a child with refractory epilepsy is not easy and families often find their emotional resources spread thin. It is even more daunting to come to the hospital for evaluation with new and sophisticated diagnostic tests, participate in discussions involving epilepsy surgery as a possible treatment option and undergo procedures such as invasive monitoring of seizures for accurate surgical planning. Many families find the weekly PESG meetings to be a source of strength and comfort during diagnosis,

Cleveland Clinic’s Pediatric Epilepsy Support Group (PESG)

treatment and following epilepsy surgery.

is designed to meet and address the needs of families who

For more information, visit clevelandclinic.org/epilepsysupport

are caring for children with difficult-to-control epilepsy. The

or email [email protected].

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CLEVELAND CLINIC’S EPILEPSY CENTER | PEDIATRIC EPILEPSY

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WHY CHOOSE CLEVELAND CLINIC? Cleveland Clinic Epilepsy Center’s pediatric epilepsy program is a

Also, learn about how our patient management

leader in diagnosing, and medically and surgically treating children

conference helps patients, our success with keeping

with epilepsy. It was one of the first programs in the nation to

many patients seizure-free and what Cleveland Clinic

introduce surgery as a treatment option for children with

patients have to say about their care. Log on today to:

intractable epilepsy. Today, our program is considered one of the

clevelandclinic.org/epilepsyvideos.

most comprehensive of its kind nationally and internationally, enriched by our multidisciplinary team approach; clinical expertise and experience; clinical and translational research; education

READY TO MAKE AN APPOINTMENT? To make an appointment for an evaluation with a

and innovation.

Cleveland Clinic pediatric epileptologist, please call 866.588.2264. To learn more about pediatric epilepsy

DOWNLOAD CLEVELAND CLINIC’S MYEPILEPSY APP TODAY.

and Cleveland Clinic Epilepsy Center, visit us online at clevelandclinic.org/pedsepilepsy. Cleveland Clinic offers

Download this free educational, interactive iPad® tool now

pediatric epilepsy consultations at:

on the App Store featuring:

Cleveland Clinic Main Campus

• Interactive Seizure Diary

Pediatric Epilepsy Center

• Medication Reminder

9500 Euclid Ave./S61 Cleveland, Ohio 44195

• MyEpilepsy Path Interactive Questionnaire • Epilepsy facts, diagnosis and treatment options • Seizure First Aid • Appointment Manager and more CHECK OUT OUR VIDEOS ON CLEVELAND CLINIC’S EPILEPSY CENTER YOUTUBE CHANNEL Experts from the Epilepsy Center will help you learn about: • How is epilepsy diagnosed? And what are EEG, MEG, WADA, EEG/fMRI and SEEG tests? • How do I prepare for a visit to the Epilepsy Monitoring Unit? • What help is available for adults and children with epilepsyrelated behavioral health needs? • Who is a surgical candidate? How can surgery eliminate seizures?

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PEDIATRIC EPILEPSY PROGRAM STAFF The staff of Cleveland Clinic’s pediatric epilepsy program is made up of a dedicated group of board-certified pediatric epileptologists, epilepsy neurosurgeons, pediatric neuroradiologists, pediatric neuro-psychologists, clinical neurophysiologists (MEG program), child psychiatrists and social workers, along with pediatric nurses, EEG technologists and child life specialists.

IMAD NAJM, MD

ELIA PESTANA KNIGHT, MD

Director, Epilepsy Center

Pediatric Epilepsy

AJAY GUPTA, MD

ELAINE WYLLIE, MD

Section Head, Pediatric Epilepsy

Pediatric Epilepsy

PRAKASH KOTAGAL, MD

WILLIAM BINGAMAN, MD

Pediatric Epilepsy

Pediatric Epilepsy Surgery

AHSAN MOOSA NADUVIL, MD

JORGE GONZALEZ-MARTINEZ, MD, PHD

Pediatric Epilepsy

Pediatric Epilepsy Surgery

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TATIANA FALCONE, MD

STEPHEN JONES, MD, PHD

Child and Adolescent Pyschiatry

Pediatric Neuroradiology

JENNIFER W. HAUT, PHD, ABPP-CN

DOKSU MOON, MD

Pediatric Neuropsychology

Pediatric Neuroradiology

PATRICIA KLAAS, PHD

PAUL RUGGIERI, MD

Pediatric Neuropsychology

Pediatric Neuroradiology

GUIYUN WU, MD Pediatric Neuroradiology

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RICHARD BURGESS, MD, PHD Clinical Neurophysiology (MEG)

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NURSE ON CALL Free, confidential, reliable information from registered nurses only a phone call away: 216.444.1234.

MYCHART Cleveland Clinic’s MyChart® is a secure, online tool that JOHN MOSHER, PHD Clinical Neurophysiology (MEG)

connects you to portions of your medical record from the privacy of your home. Utilize this free service to manage your healthcare at any time, day or night! • View test results • Renew prescriptions

PAUL FORD, MD Bioethics

• Schedule appointments online in real-time with your primary care physician • Manage your health on the go with our free MyChart mobile app • Request appointments with your specialist • Receive important health reminders • Manage the healthcare of your dependents and loved ones with MyChart Caregiver. For more information or to sign-up, log on to clevelandclinic.org/mychart.

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9500 Euclid Ave., Cleveland, OH 44195 Cleveland Clinic Children’s provides comprehensive medical, surgical and rehabilitative care for infants, children and adolescents. Our more than 300 pediatric physicians accommodate more than 800,000 outpatient visits and 18,000 inpatient admissions per year at the children’s hospital and outpatient facilities on our main campus, at the Cleveland Clinic Children’s Hospital for Rehabilitation campus, and at community hospitals, family health centers and other locations across Northeast Ohio. Cleveland Clinic Children’s & Pediatric Institute is one of 27 institutes at Cleveland Clinic designed to offer highly integrated care and conduct innovative research across multiple settings. It is backed by the full resources of Cleveland Clinic, a nonprofit academic medical center ranked among the nation’s top hospitals (U.S. News & World Report). clevelandclinicchildrens.org ©2014 The Cleveland Clinic Foundation

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