Controlling seizures: key to epilepsy treatment

The telltale sign of epilepsy is repeated seizures, which happen when abnormal electrical activity in the brain causes momentary changes in awareness, movement, speech, vision and behavior. Seizures can be partial (affecting only part of the brain and body) or generalized (involving the entire brain surface and body).

In the United States, more than 300,000 kids under age 15 have epilepsy. About 90,000 of them experience seizures that are difficult to control.

In most cases, epilepsy occurs all on its own, but sometimes it’s related to an underlying condition like a brain tumor or genetic disorder. At our pediatric level 4 epilepsy center, we’ve established special programs for kids with two common seizure-related disorders:

• Tuberous sclerosis complex — A genetic disorder that causes tumors to form in many different organs, primarily in the brain, heart, eye, skin, kidneys and lungs
• Chromosome 15 abnormalities — A change in certain genes that has been linked to epilepsy and intellectual disabilities

Seizure prevention and treatment

Treatment for epilepsy focuses on seizure prevention and can include medication, surgery, or a special diet.

Medication

The first line of treatment is seizure-preventing drugs. Different drugs control different types of seizures, and a medication that helps one person may not be effective for someone else. Whenever possible, doctors try to control seizures with just one drug. If seizures are not controlled after trying two different medications, surgery evaluation should be considered.

A pharmacist with extensive knowledge of drug interactions, side effects, drug serum levels and customized dosage of medications is part of the comprehensive team delivering the most up-to-date drug treatment options. We also offer access to the latest clinical trials for epilepsy medications.

Surgical options for epilepsy treatment are not a last resort

If medications aren’t controlling seizures, it’s important to consider surgery as early as possible. That’s because uncontrolled seizures affect how a brain functions, and stopping or reducing seizures will minimize the impact on a child’s development. In children, it’s possible for functions like movement and language to be controlled by a new part of the brain if the original area is unable to do so.

As a level 4 pediatric epilepsy center we offer advanced surgical methods that have led to greater seizure control success rates, improvement in quality of life and development, and improved surgical outcomes.

The pre-surgery evaluation at Children’s includes expertise from neurology, epileptology, neurosurgery, neuropsychology and radiology. Diagnostic tests used to assist with decision-making include:

• Stereoelectroencephalography (SEEG)
• Video electroencephalographic (EEG) monitoring
• Magnetic resonance imaging (MRI)
• Neuroimaging
• Functional MRI (fMRI)
• Magnetoencephalography (MEG)
• Neuropsychological testing

Types of surgical interventions

• Resection — The surgeon removes the small section of the brain that is causing seizures, while carefully avoiding areas of the brain related to specific functions such as language and memory. This procedure is done using a craniotomy, a temporary opening in the skull.
• Ablation — In this minimally invasive procedure, a surgeon uses a laser to ablate, or wear away, lesions that may cause seizures. Ablation can result in a faster and easier recovery than a craniotomy.
• Corpus Callosotomy — To control (but not eliminate) seizures, the fibers between the two halves of the brain are disconnected.
• Hemispherectomy — When a severely damaged or abnormal hemisphere is causing seizures, the surgeon may remove a partial or complete half of the brain.
• Vagus nerve stimulator (VNS) is a surgically implantable device suitable for children whose seizures are not well-controlled with medications and who are not candidates for other surgical interventions. A VNS works to eliminate or lessen the severity of seizures by sending small pulses of electrical current to the brain.

Ketogenic diet

At our epilepsy center, roughly two-thirds of patients achieve at least a 50 percent improvement in seizure control with the use of ketogenic diets. The dietary regimen relies on a high-fat, adequate-protein, and very-low-carbohydrate ratio. Patients are closely monitored during the fasting stage of the diet and a registered dietitian assists with planning and preparation of the meals for patients following a ketogenic diet.