Treatments for Epilepsy in Children
One option for some children with epilepsy is surgery. You may be frightened by the idea of your child having brain surgery. It's definitely a treatment reserved for a select few. But while surgery for epilepsy may be a radical step, improvements have made these operations much safer and more effective.
"In the old days, doctors would wait 20 years before trying surgery in a person with epilepsy who didn't respond to medication," says William R. Turk, MD, chief of the Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida. "That would mean 20 years of seizures. Now, we're trying to catch those people earlier, to identify the kids who aren't responding to medication and who might benefit from surgery."
In some cases of epilepsy, doctors can locate the specific part of the brain that is causing the seizures. Once the area is identified, a surgeon may be able to remove that section of the brain without causing any other problems.
In some cases where the origin of the seizures may not be clear, your doctor may suggest a surgical procedure using intracranial electrodes -- electrodes that are placed on the surface of or inside the brain -- to get more information. In one type of procedure, a surgeon would cut open your skull and place a grid of plastic embedded with electrodes on your brain. The electrodes then monitor your brain's electrical activity. This test may help determine the focal point of your seizures, and allow you and your doctor to decide whether further surgery makes sense.
The most common type of epilepsy surgery is a lobectomy, in which the focus of the seizures (where the seizures originate) is removed from a lobe of the brain. The most common type of lobectomy, a temporal lobectomy, stops or greatly improves seizures in up to 85% of people. Most patients will continue on seizure medication, although it will usually be a reduced amount compared to before the surgery.
Other types of surgery are used when the seizures can't be localized to a specific part of the brain. Among these are:
Multiple subpial transection. In this surgery, cuts are made on the surface of the brain, in the specific parts causing the seizures.
Corpus callosotomy. In this surgery, the link between the two hemispheres of the brain is cut.
Both operations can prevent seizures from spreading.
A hemispherectomy is another procedure in which up to half of the entire brain is removed. These surgeries have greater risks, but they can make a huge difference for children with uncontrolled seizures and related disabilities.
Surgery isn't an option for every person with severe epilepsy. If the epilepsy is the result of a number of lesions on different sides of the brain, surgery won't be effective.
Making the decision to have surgery is difficult. You don't need to rush into it. Unless there's a tumor that's causing the seizures, there's no special urgency. Learn about the surgery and its alternatives. Make sure that you -- and your child -- feel absolutely sure of the surgery before deciding to do it.