Taming Seizures
by Eve Jacobs

Left to right: Sheila Jackson, chief neurophysiology technologist; Martha Mulvey, advanced practice nurse; Jayoung Pak, MD, PhD, assistant professor of pediatric neurology/epileptologist,; Malissa Matos, secretary Neurosciences

So, back she went for round two at UMDNJ. “A little bit bold” is how she describes herself, and it is that bit of boldness — drawn upon time and time again — that has propelled her through some very tough periods of her life.

Pak, an only child of poor parents, was raised in a very small town in a coal mining area in the “middle of nowhere.” Her father was not a coal miner, but worked for the company.

“I was not smart,” she says. Hard to believe when you know that she is consistently one of Castle Connolly’s top
doctors in the ultra-specialty of childhood epilepsy.

Not smart? “No, really,” she says. “There were 65 kids in an average class in my school, and I was always number 62 or 63.

“I was said to be a stupid child. You had no future in Korea if you were in the bottom 5 percent.”

Paks’ parents had an arranged marriage, which she says, “didn’t go well.” Her mother had been raised in the city and was depressed, living so far away from family members and friends.

“My family was not among the happiest and growing up in my house wasn’t easy,” she says. Raising Jayoung to successfully outgrow their confined circumstances became her mother’s mission. Excelling in school was the only path to achieving that.

In ninth grade, Pak says, her life suddenly turned around when she placed 63 out of 1,200 students taking a high school entrance exam. That success also convinced her that her childhood dream was still within reach. “On my way to church at age 6, I saw an old man who was very sick lying in the street,” she says. “I made up my mind then to become a doctor.”

Add stubbornness to the list of qualities Pak believes worked in her favor. She also calls herself “obsessive” in relation to her studies from that point onward.

Not only did she continue on her meteoric rise through high school and college, but also gained entry into one of the best medical schools in Korea and graduated in the top of her class. “You have to be number one in the class to keep a full scholarship,” she explains, and she managed to do that. There was no room for failure.

Her studies were rigorous and the commute to classes crowded and difficult, but Pak found studying medicine “fun.” She discovered a talent that has served her well — a natural ability to remember scientific and medical information.

“I don’t have to memorize anything,” she says. “It’s incredible — I focus on the information and I’m able to remember all of it.” Pak finished her residency in ’83 and earned a PhD in clinical pediatrics in 1985 in Korea.

With a string of successes to her name, why did the young pediatrician decide to emigrate from her native country? “There’s very little pediatric subspecialty training in Korea,” she says. And she was determined to learn more than her five years of general pediatrics residency had taught her.

In 1985, nine months pregnant with her first child, Pak came to the U.S. with her husband. (She has two children and both have expressed an interest in becoming physicians.) She initially wanted to study pediatric cardiology, but she credits Richard Konigsburger, MD, a child neurologist and then chief of the division at NJMS, with changing her mind.

“I had no foundation in neurology, no basics, but he wanted me to do a fellowship in this area,” she says.

With little background in the field and extensive language difficulties, Pak often felt she was in over her head: “There were many times I was going to quit, I would cry, it was too hard.”

But Konigsburger, who came from Columbia University to establish the division at NJMS, became her mentor and “taught me so much,” she says. Pak stubbornly persisted.

Despite her somewhat bumpy beginnings, the physician proved herself a pro. Her boldness, her stubbornness, her “obsessive” nature, and her joy in learning powered her momentum to a place she never imagined.

Three tough fellowship years in pediatric neurology at NJMS, followed by two years postdoctoral fellowship training in epilepsy, epilepsy surgery and neurophysiology at Columbia Presbyterian Medical Center, prepared her to return to the Newark campus in 1993 to found the University’s pediatric epilepsy program. She knew that when it came time to choose her life’s work, she wanted to be able “make a change in patients’ lives.” And that she has been able to do.

In the service she established at UMDNJ-University Hospital (UH), she has cared for more than 3,000 patients since 1993. Although she was tempted to continue at Columbia, she felt her expertise was most needed in Newark. Inner city blacks and Hispanics — the focus of her practice — seem to have particularly bad cases of epilepsy, she notes.

She counts herself lucky to have been involved with the first epilepsy surgery performed on a child at UH in 1995. The surgeon was Peter Carmel, MD, chair of neurological surgery at NJMS and UH, whom she has collaborated with for a decade. “That patient was 7-year-old boy who had nocturnal seizures. His mother said she had never slept through the night since he was born, and she was desperate,” Pak says. He remains seizure-free today.

“An entire family’s life changes when you successfully treat a child with epilepsy,” she says. “It’s so rewarding.”

Her work demands 14-hour-days on average, and often spills over onto weekends. For about 70 percent of patients with epilepsy, seizures can be controlled — even if not eliminated —with the right drugs. Surgery generally is reserved for children whose seizures are not controlled with anticonvulsants. Pak describes the surgery as “amazing,” saying the area to be targeted by the procedure is pinpointed by “putting the electrodes over the brain and finding where the seizure is starting.”

“If the patient has a single seizure focus, the surgery can be done without damaging other structures,” she explains.

She credits her team — which includes a neurosurgeon, neuropsychologist, neuroradiologist, nuclear medicine specialist, dietician, social worker, three technicians in a video EEG monitoring unit, a nurse coordinator and a secretary — with consistently going above and beyond the call of duty to provide patients with optimum care, and their families with a high level of comfort. “We can offer children three or four options for treatment here,” she says. “Many of them were dead-ended before.”

Patients range in age from newborns through adolescents. Pak says the youngest epilepsy surgery patient was 11 months old and had been transferred from St. Barnabas Medical Center. “She was a very sick child and she was hospital-bound for seven months,” says the physician. “We were able to stop the seizures and waited until she had recovered from all other complications and then we brought her back for the surgery when the time was right.” The child is now 8 years old and doing well.

Pak explains that the earlier epilepsy is diagnosed and treated, the better. The seizures can affect development, she states, impacting the child’s ability to pay attention, his memory, and behavior. “When seizures aren’t controlled, the child can have learning difficulties and behavior problems, and may become depressed,” she says.

When medications fail to control a child’s seizures, Pak sometimes recommends a ketogenic diet (high in fat, low in carbohydrates, restricted calories), which forces the body to burn fat for energy, rather than glucose. The child is given three or four times as much fat as carbohydrates and protein combined. All foods must be weighed and measured.

Data indicate the diet is effective in eliminating or reducing seizures for two of every three children who try it. Some children on the diet can eventually discontinue their medication, while others can reduce the amount of drugs they need.

Vagal nerve stimulation is another treatment avenue for children who are unresponsive to medication and are not candidates for surgery, states Pak. A neurosurgeon implants a generator about the size of a small tape measure in the upper left area of the chest; and a connecting wire is run under the skin from the device to the vagus nerve in the left side of the neck. Three small leads are then attached to the nerve. The generator is programmed to stimulate the vagus nerve at regular intervals, which can be adjusted by the physician using a computer.

Studies indicate that many patients experience a 50 percent reduction in seizure frequency, and seizures are less severe, explains the epilepsy specialist. It also eliminates seizures in some patients.

Needless to say, taking care of children with epilepsy, and their families, requires an enormous commitment of time and energy, which can be provided by multidisciplinary teamwork. Pak says she has been called an “old dinosaur”— not putting limits on the time she spends with her young patients and their parents. “Sometimes I go too far,” she admits.

“But these kids have a very tough life and, often, no one has been able to help them,” she continues. “If I can make a difference, any difference, I just keep going and going and going.

“The children know when you really care about them. They put all their trust in you — and what happens is something like magic.”