Strickler launched her own art studio shortly after graduating from the prestigious School of the Art Institute of Chicago in the late 1980s. She painted murals at more than 100 Chicago restaurants, hotels, nightclubs and bars, and relocated to Southern California shortly before her seizures began in 2007.

“Every month or so, I would have another seizure and wake up in the hospital about four days later,” Strickler said. “Little by little, the business I had built up came to a halt. After a seizure caused a major car crash where, thankfully, no one was killed, I had to give up driving. My life was absolutely leveled.”

Jeffrey M. Chung, MD, director of the Epilepsy Program at Cedars-Sinai, met Strickler in 2019 when she was referred by a former Cedars-Sinai resident.

“Syril had been prescribed many different medications and they were not controlling her seizures, which were frequent and severe,” Chung said. “If a patient’s seizures aren’t controlled by the first two medications they try, there is less than a 5% chance that additional medications will help. It was time to look into other treatment options.”

To locate the exact point in Strickler’s brain where her seizures were originating, the epilepsy team first monitored her seizure activity using EEG electrodes attached to her scalp. When that didn’t yield enough information, Adam N. Mamelak, MD, director of the Functional Neurosurgery Program at Cedars-Sinai, implanted electrodes at various locations in Strickler’s brain to make more precise recordings possible.

During a hospital stay of several days, Strickler also volunteered to assist Cedars-Sinai investigators by performing experimental tasks similar to computer games while they recorded the activity of cells in different regions of her brain—something possible only in patients who are undergoing invasive EEG monitoring.

“The data from these experiments is rare and precious, and allows us to discover how the brain works,” said Ueli Rutishauser, PhD, director of the Center for Neural Science and Medicine at Cedars-Sinai. “We have used this data to gain insights into how the brain records and recalls memories, how it makes decisions, and how these processes go wrong in certain conditions. And for the patients, we’ve found it is uplifting and empowering, because it gives them the chance to contribute to science and possibly help develop new treatments that help future patients.”

Strickler said that working with the research team helped brighten her time in the Epilepsy Monitoring Unit. “We had a great time, and I still keep in touch with them,” she said. “It was neat that I got to be involved in that.”

If a patient’s epileptic seizures originate from a single point in the brain, surgeons can remove a tiny portion of tissue at that point to stop them. Because Strickler’s seizures were coming from two points, Mamelak suggested an alternative treatment called neuromodulation.

“We found that most of Syril’s seizures were originating in the right hippocampus, but some were coming from the left,” Mamelak said. “We placed permanent electrodes in each of those locations. They are connected to a tiny device implanted in her skull that detects seizures just as they are starting and delivers electrical pulses to shut them down.”

Mamelak said that advanced imaging and robotic surgery have significantly reduced the risks from these procedures, and that patients have more treatment options than ever before. Chung noted that long-term neuromodulation with the device used to treat Strickler results in at least a 50% reduction in seizures for more than 70% of patients. Strickler has been seizure-free for more than a year.

“I’m busy painting again and am about to graduate from Ventura Adult and Continuing Education with a certificate in print and web design. I just started a new job doing video painting tutorials for an L.A.-based manufacturer of plasters and decorative paints,” Strickler said. “And after 6 ½ years without a driver’s license, I am able to drive. I feel like I’ve been given an absolute miracle.”

Chung, who has now begun weaning Strickler off her anti-seizure medications, urges patients who have tried more than two medications and are still having seizures to seek out an evaluation at an epilepsy center.

“With a proper evaluation, you can learn what your options for treatment are and make a conscious choice,” Chung said. “The saddest thing is when we have options that could stop a patient’s seizures, and they're not being evaluated for those options.”

Read more on the Cedars-Sinai Blog: Personalized Epilepsy Treatment for Each Child

“Every day in clinic I see children who have had for years what many people call ‘funny spells,’” Holder said. “Sometimes I start talking to a parent and find out the parent has had ‘funny spells’ for years, but had no idea they were epileptic seizures.”

That’s because many people with epilepsy experience subtle symptoms, such as not being able to talk for a few seconds, Holder said. When the momentary symptoms disappear, people tend to forget to look for the source.

“Sometimes children experiencing seizures will see flashing lights or have temporary blurred vision, which leads them being misdiagnosed with migraine,” Holder said.

About 1 in 26 Americans are thought to have epilepsy, a neurologic condition in which a person experiences seizures, or episodes of abnormal electrical activity in the brain.

To mark National Epilepsy Awareness Month, Holder spoke with the Cedars-Sinai Newsroom about what seizures can look like—and why it is important that children get help as soon as possible.

What does a seizure look like?

A seizure can look like anything, depending on where in the brain the seizure comes from. A lot of people think a seizure is a convulsive seizure, where there's a loss of consciousness and the person falls down to the ground and the whole body experiences convulsive activity. That's actually the rarest type of seizure.

The most common seizures are barely noticeable. Sometimes a patient will just sit and stare and be unresponsive for three or four seconds. A child may have an uncontrollable motor activity, such as twitching of an arm or one leg or twitching of one side of the face that lasts for 30 seconds.

Patients may get a feeling of numbness or tingling in a part of the body, or get a funny smell or taste in the mouth that comes and goes. Sometimes they're not able to process language, and their speech is garbled.

If a child has the same feeling or sensation or behavior that happens over and over again, that is a sign the child might be having seizures.

How do you diagnose epilepsy in children?

We rely a lot on information we gather by talking to families. Often, we can make the diagnosis without any diagnostic test, although we still do an EEG, an electroencephalogram, to see if we can gather any further information. For this test, we place electrodes that look like little stickers on the head so that we can monitor brain waves.

How have smartphones changed how pediatric epilepsy is diagnosed?

I've been doing this for more than 20 years, and one of the things that has been most helpful to me is the advent of cell phones with video recording. I advise families, if you see a child having a funny spell, get it on a video camera. We are very good at being able to tell by looking at the recording if the event is a seizure or not.

What happens if a child is not diagnosed promptly?

Children are learning to read, write, think. Undiagnosed seizures can interfere with a child’s ability to learn and process information.

How do you treat epilepsy?

Most children are able to be seizure-free on medications alone. As the brain grows and develops, many children will outgrow seizures and not need to take medication long term.

More than a third of patients have seizures that are more difficult to control. For those children, we typically do advanced diagnostic testing to see exactly where the seizures are coming from. We then remove the part of the brain causing the seizures. Nowadays, this can be done by making a very small opening in the brain and treating the affected area with a laser. The opening is closed with just one suture and the patient usually goes home the next day.

Is epilepsy genetic?

Scientists have identified more than 500 genes that are associated with epilepsy. When we do genetic testing, we can tell not only what causes the epilepsy, but also which medications to use. We do genetic testing by swabbing the cheek. It takes five minutes.

We have a very strong genetics program at Guerin Children’s. The really exciting news is that we have, for the first time, a gene therapy in trials in patients with epilepsy. We may one day be able to treat children with this therapy.

Read more on the Cedars-Sinai Blog: Myths and Facts About Epilepsy

“Drs. Holder and Ochoa bring years of expertise and knowledge in the treatment and management of pediatric care, with a commitment to offering personalized strategies for each patient and their family,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health. “We are confident both of these remarkable physicians will propel our pediatric capabilities.”

Holder is an expert in caring for children with pediatric epilepsy, the most common childhood brain disorder in the U.S. She joins Cedars-Sinai from Children’s Hospital Los Angeles (CHLA), where she was director of the California Children’s Services Special Care Center for Epilepsy and director of the Epilepsy Fellowship Program.

She was also an associate professor of Neurology at the Keck School of Medicine of USC.

Prior to those positions, Holder directed the Comprehensive Epilepsy Center at CHLA and the epilepsy surgery programs at CHLA, Pittsburgh Children’s Hospital and Cincinnati Children’s Hospital Medical Center.

Holder conducts medical research and has worked on studies investigating outcomes related to epilepsy surgery and vagus nerve stimulator placement, as well as potential new treatments for epilepsy.

A graduate of the Medical College of Ohio, Holder completed an internship in pediatrics and residencies in child neurology and pediatrics with Texas Children’s Hospital and Baylor College of Medicine. She also completed a fellowship in clinical neurophysiology and epilepsy with Children’s Hospital Boston and Harvard Medical School.

“I look forward to working with the team at Guerin Children’s to offer all available diagnostic and treatment options for newborns to adolescents,” Holder said. “This will allow for a seamless transition to the adult epilepsy program so people with epilepsy can receive state-of-the-art, comprehensive services at Cedars-Sinai throughout their lives.”

Ochoa is a developmental-behavioral pediatrician with expertise in assessing and managing attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, learning and cognitive disabilities, speech-language disorders, and other developmental and behavioral challenges in children and teenagers.

“I’m excited to build a program that provides state-of-the-art medical care to children and adolescents with developmental and behavioral conditions,” Ochoa said. “The goal is to improve our patients’ trajectories and long-term outcomes.”

Previously, Ochoa was chief of the Division of Developmental-Behavioral Pediatrics and associate professor of Pediatrics at the Rush University Medical Center in Chicago. There, he established a multidisciplinary program for children with ADHD, autism and neurodevelopmental and neurogenetic conditions.

Ochoa has been the principal investigator in clinical trials studying treatments for conditions such as Angelman syndrome, Pitt Hopkins syndrome, Dup 15 syndrome, Down syndrome and autism.

After earning a medical degree from the Universidad Peruana Cayetano Heredia in Lima, Peru, Ochoa completed a residency in pediatrics with the University of Illinois Chicago Medical Center. He also earned a master of public health degree from the University of Illinois Chicago School of Public Health.

“We welcome Drs. Holder and Ochoa to our team and look forward to the compassionate and expert care they will offer families,” said Shervin Rabizadeh, MD, MBA, associate director of Guerin Children’s and chair of the Department of Pediatrics.

Read more in Discoveries: Innovation and Collaboration in Pediatrics at Cedars-Sinai Guerin Children’s

Follow Cedars-Sinai Guerin Children’s on Twitter for more children’s health news from Cedars-Sinai.