Dr. Keator, who is a pediatric neurologist and epileptologist at Cook Children’s, began volunteering at Cook Children's at the age of 14 as a title holder with the Miss Texas Organization. Along with many of the other titleholders, she would perform her talent for patients in the atrium. Back then she performed ventriloquist routines.

“My fondest memory is being in the Atrium performing and you look up and see all the children and their parents looking down and watching you,” she said. “It was so daunting then and now I walk past it all the time.”

Then in 1998, through a senior internship program during her senior year at Trinity Valley School, she spent her spring semester with Hematology and Oncology at Cook Children’s.  

The department held a special place in her heart because her cousin battled cancer there. That stint with the doctors made such an impact on her that after completing her internship, she continued to volunteer at the medical center.

When asked if she always wanted to be a doctor, Dr. Keator said, “I always knew I wanted to do something in the medical field. We all have that childhood dream of what we want to be when we grow up, and even then I always wanted to help people, especially children.”

As a volunteer, she tried to ask good questions and absorb as much knowledge as possible to prepare her for medical school. She learned the importance of listening to the patients and their families. She also saw science come to life. It wasn’t just about studying words in a book; it was seeing how medicine and medical care actually worked.

“Volunteering here I also realized how little I knew!” Dr. Keator said. “Just regular biology or chemistry class in high school is nothing compared to what people do in real life. It was a process, where I learned that being a doctor was about more than just being smart, it really takes a lot of compassion and motivation. I was able to see the interaction of the doctors and nurses with the patients. I realized I had so much more to learn than what was just in a textbook. ”

It was through her volunteering at Cook Children’s that she developed her interest in working with children, especially those needing chronic or long-term care. “I learned my true passion of wanting to help others was the relationships you develop with your patients and their families,” says Dr. Keator. “In neurology, we care for many children with neurological conditions that require close follow up and care, as many of our patients are cared for from birth through adulthood. Of course, I enjoy the pathophysiology of neurological conditions, especially epilepsy, but, what I also love about my field is that you become part of the team and you truly get to know the family.”

Now at Cook Children’s, Dr. Keator sees new people learning those same life lessons. “I see volunteers today at Cook Children’s and they are all age groups who choose to spend time with our patients. I’m so thankful so many people want to come here and volunteer and help with the children. It’s pretty incredible. “Everyone should volunteer. It’s good for the soul.”

Dr. Keator said that working at Cook Children’s is “totally surreal” because it was everything she aspired to do as a child. “It’s really cool to look back and say, ‘Wow, I did it.’”

But other than that it would be hard to notice a difference in him and any other 5-year-old boy after becoming the first child at Cook Children's to undergo a trailblazing endoscopic epilepsy surgery.

Owen’s story begins at 8 months of age when his parents notice weakness on his right side. His parents know something isn't right with their son and they make an appointment for Monday with their pediatrician. But over the weekend they become afraid when they see Owen has stopped using the right side of his body.

His parents rush Owen to the nearest emergency room in Cleburne, Texas. From there, he's airlifted to Cook Children’s by CareFlight.

His initial scans show a large stroke in the left side of his brain which is soon discovered to be related to a new diagnosis of acute myeloid leukemia. He endures four phases of chemotherapy and fortunately enters remission where he remains today. While his stroke left him with right-sided weakness requiring ongoing aggressive therapy, it's his seizures that prove to be the most debilitating obstacle to overcome.

“We were so fortunate,” Allison Turner, Owen’s mom, said. “That's the day we met (Kenneth Heym, M.D.), who would become Owen’s oncologist. He happened to be on call that weekend. He met us there. He told us at that point, our kid was one of the sickest in the hospital. If we had waited to bring him in until the next day, Owen may not have made it.”

Owen’s first seizures occur in the days following the stroke, but they are controlled with medication. He’s even able to stop taking medication shortly after his initial diagnosis, but the seizures returned around age 3. His parents describe his seizures as periods of suddenly pausing in activity with a decreased response to them and sometimes unprovoked laughter. Other events are described as a sudden fall to the ground or stiffening and shaking of his arms and legs posing a significant risk of injury. Despite trials of at least six different medications – nothing helps his daily seizures.

His neurologist at Cook Children’s, Howard Kelfer, M.D., refers Owen to the Cook Children's Justin Comprehensive Epilepsy Program for epilepsy surgery evaluation. Once Cynthia Keator, M.D., took over his case, she begins a workup to determine where in the brain his seizures were arising, understanding the likelihood of seizure control with medications is minimal. Owen’s evaluation in the EMU (epilepsy monitoring unit) captures many seizures starting from the left hemisphere. Additional evaluation with a MEG (magnetoencephalogram) scan shows multiple areas of abnormal electrical activity throughout the left hemisphere both in front and behind the region of his prior stroke.

Given that his seizures arise from such a large area of Owen's brain, the epilepsy team feels his best chance of seizure freedom is to disconnect the left side of his brain from the right by cutting the fibers (corpus callosum) that connects the two sides of the brain.

One traditional approach to this type of surgery is corpus callosotomy, which often involves a large incision on the patient’s skin, opening a large hole in the skull, and then cutting the corpus callosum in half. While considered by many to be the “gold standard” with good seizure control rates, after-surgery care involves a lengthy recovery in the hospital and then at home. While Owen’s family wants better seizure control, they’re reasonably hesitant to undertake such an invasive surgery.

Fortunately, Cook Children’s neurosurgeon, Daniel Hansen, M.D., is one of only a few pediatric neurosurgeons in the United States who has experience doing similar procedures, using less invasive endoscopic techniques. Endoscopes (small video cameras with channels for operating tools) allow the surgeon to perform surgery through much smaller openings in the skull. When successful, this means a smaller incision, less surgical blood loss, quicker operating time, shorter hospital recovery, and the same chance of seizure freedom post-operatively as if undergoing a more traditional open surgery.

Owen’s family understood that endoscopic epilepsy surgery is the leading edge of advancement and their child would be the first such surgery at Cook Children’s, and one of only a few in the country that have been reported.

“Giving their consent and placing trust in our team, we went forward with surgery,” Dr. Hansen said. “The operation itself went well. We were able to completely disconnect the two hemispheres of the child’s brain using a bony opening not much larger than an inch square, and his recovery in the hospital was quick.”

“After everything we’ve been through, I don’t know if you ever say you are comfortable. I guess we’ll always be on guard,” Allison said. “But we’re a little more relaxed now. Before the surgery, we never knew when a seizure would come on. Owen couldn’t go outside and play without one of us with him.”

Owen is now 9 months out of surgery and the family has noticed no seizures since. He’s an active young boy who is making steady strides in kindergarten now that his uncontrolled seizures have stopped. While it remains too early to speak to years of seizure control, doctors say this is an encouraging start.

Given the successful outcome with Owen, Cook Children’s has since performed two additional procedures with similar favorable results. The Epilepsy team hopes to expand the number of children who are candidates for this type of surgery in the future. Such children will have medically refractory epilepsy and will have undergone a thorough evaluation by the team at Cook Children’s. Potential surgeries that can be performed endoscopically include complex surgeries including corpus callosotomy, single lobe disconnections, focal lesion resection, and functional hemispherectomy. As the team’s experience grows with this technology and technique, its use may expand beyond this short list.

And in the process changing more lives for the better.

“It has been such a relief for us. It was a huge decision to disconnect his brain. Just saying those words … But this was the best thing for him,” Allison said. “He has flourished. He’s made improvements by leaps and bounds. Just the progress in everything. His speech, school work, everything. His whole body is functioning with just the use of one side of his brain. He can’t throw a football with his right hand and he has problems with his fingers on his right hand. He can’t pick up a Cheerio with his right hand. But other than that, I don’t know if anyone would notice a difference in him and any other child.”

It can be a hard thing for adults to deal with. Unfortunately, many children suffer the same pain. For some, it’s a genetic condition that’s been passed along to them. But for others, migraines are the result of injury. For 15-year-old Olivia Gillespie, her migraine problems began when she received her third concussion.

“It happened in cheerleading practice, I was kicked in the head,” says Gillespie. “I was fine. I didn’t think it was that big of a deal.”

Then months later, Gillespie was on a ski trip with her youth group when a headache came on and never went away.

“I just kept doing what I was doing and tried to not let it have an effect on me,” she said.

Gillespie tried to ignore the pain for two months before she said anything to anyone, but then the pain got worse.

“Olivia had an ongoing headache that would not fade. On a scale of one to 10, it was a consistent five," said Amelia Gillespie, the teen's mother. "It wasn't until her pain reached level seven that it really began to affect her.”

When Cynthia Keator, M.D., pediatric neurologist at Cook Children’s, first saw Olivia, she wanted to make sure her headaches could be treated without medication. Together, they worked on her sleep habits and diet. Dr. Keator also suggested supplements such as B2, and Omega 3, which has shown to help with headaches. In addition, Gillespie was referred to the Biofeedback Clinic at Cook Children’s.

“Biofeedback teaches patients how to control their pain by controlling their breathing, heart rate and body temperature,” says Dr. Keator.

Biofeedback specialist Nanny Christie, Ph.D., has been teaching the painless technique for decades.

“We place the child in a reclining chair and use pads to measure their body activity,” says Christie. “The equipment plugs into a laptop so the kids can see everything on the computer screen. If they tighten a muscle, a line goes up. If they relax, the line goes back down.”

Christie says teaching children to harness their breathing and muscle movement this way allows for real time learning. She says about 80 children are seen in her clinic each month. A typical visit is 45 minutes to one hour and each child is seen roughly four times.

While it wasn’t the end-all, be-all cure for Gillespie, it did help. She says she uses the technique to curb her head pain. If she feels a headache becoming worse, she can focus and calm her anxiousness which in turn can help the headache.

Also, ask your doctor about preventative medication. Your doctor may prescribe something prescription strength or a natural supplement to ease the pain.

Make sure you DON’T ask your child this question:

“How’s your headache?”

You may want to, but remember that asking about a headache is like scratching a mosquito bite. By asking, you’re reminding your child about their pain.

Still, Dr Keator takes precautions.

She states, “I suffer from migraines, as due several of my colleagues. Most migraine sufferers have busy lifestyles, and a main trigger is fatigue. Therefore, what I tell my patients and also practice myself: exercise regularly, stay well hydrated, eat well and get adequate sleep. Another very important recommendation is to limit time on electronic devices. I do my best to minimize migraines and headaches by taking frequent computer breaks.”

Most professional and educational activities are spent on some sort of electronic device, and in today’s world, introduction to electronic devices starts at a very young age. Media is everywhere and it is competing for children’s attention.

Statistically speaking, over 75 percent of children have some degree of hand-held or electronic devices. A great portion of the child’s day is spent on these devices, which by default, take away from other activities. Headaches and/or migraines in children can be exacerbated or increased due to spending excess time using electronic devices: watching TV, video games, texting, playing on tablets, etc.

The concern is that the time spent (and the content) on the devices may interfere with other regular childhood activities and natural sleep/wake cycle, especially when used in excess. Dr Keator states, that when children use electronic devices in excess, this leads to interruption in sleep which will lead to fatigue, and for many children it can lead to headaches/migraines. It can also lead to attention problems, school difficulties, eating disorders and obesity. Prolonged time spent on electronic devices interrupts other activities: homework, dinner time, family time, exercise, and sleep.

The American Academy of Pediatrics recommends limiting or completely eliminating screen time for children under the age of 2 years. Then as children get older, media is slowly introduced. For children age 3-5 years, limit to 30-60 minutes; children age 6-9 years 60-120 minutes a day; and for older children over 120 minutes is allowed.

But let’s be realistic; these time limits no longer fit in our current world of technology.

“Technology is here and electronic devices are a multi-billion dollar industry and it is not going anywhere,” Dr Keator states. “In neurology, our recommendation is time limits. The younger you are, the less time that is allowed. However, everyone needs breaks regardless of the age. Try to limit time on electronic devices to 15-30 minute increments followed by breaks. During the breaks, I recommend doing something outside, spending time with friends or family, or just resting; then resume activity on the particular device.”

Dr Keator does acknowledge that many schools are incorporating computers or touch screens into the academic curriculum. For children who are migraine or headache suffers, she recommends getting up and relaxing the eyes and giving the brain time to rest.

“It’s a balance,” she emphasizes. Parents and teachers have to work on positive media/electronic use with time limits and breaks. Media/electronic devices should not be in the bedroom and this includes smart phones. Make dedicated family time without electronics. When electronics are used, make sure it is monitored and make it educational as much as possible.

More about Dr. Keator

Dr. Cynthia Keator joined Cook Children's Neurosciences in July 2012. She is board-certified by the American Board of Psychiatry and Neurology with special qualifications in Child Neurology and sub-specializes in pediatric epilepsy. A good portion of her clinical practice in spent in the Epilepsy Monitoring Unit at Cook Children's Medical Center where she diagnoses and treats patients with epilepsy. 

Dr. Keator is a native of Fort Worth where she was raised and attended Trinity Valley School for 13 years. Uniquely, she volunteered at Cook Children's when she was in high school. "I can truly say that it was my volunteer experience that attracted me to pediatrics andCook Children's. Now having finished my training, it was an easy decision to choose Cook Children's". Dr. Keator completed her undergraduate training at Texas A&M University and then obtained her medical degree at the University of Texas Health Science Center at Houston.

Dr. Keator's husband is also a native of Texas. They live in Fort Worth with their German Shepherd. Dr. Keator enjoys spending time with her family who still reside in the DFW area.