How to Treat Focal Onset Seizures in Children

Medically Reviewed by Dan Brennan, MD on March 14, 2022
4 min read

When it comes to treating your child's focal onset seizures, which used to be called partial seizures, you have several strong options to choose from. The goal with any of them is to try to stop the seizures entirely. When that's not possible, you aim to cut down on how often they happen and how severe they are.

The best treatment depends on what causes the seizures, how they affect your child, and your child's age and overall health. And, as always, you need to think about possible side effects.

That's why it's important to have a doctor you trust. As you talk through the choices, make sure to bring up your concerns and ask questions about anything you're not sure of.

For half the kids who have a seizure, it's a one-time thing. They'll never have another one. If there was a clear cause for it, like a head injury, low blood sugar, or infection, then your child gets treated for that condition. The seizure itself was just a symptom.

If there isn't a clear cause for a first seizure, you'll likely take a wait-and-see approach, unless:

  • Results of an EEG, a test that measures brain activity, look off.
  • The seizure was 15 minutes or longer.
  • Your child has a higher chance of having seizures.

It's usually with a second seizure that you start with common epilepsy treatments.

Anti-epilepsy drugs are almost always the place to start, and for good reason. It can take a little trial and error, but they tend to work for most kids.

Your child will get a medicine to take every day that helps keep seizures in check. Some kids may also need what's called a rescue treatment, which are used mostly in emergencies.

They come in many forms including pills, sprinkles, syrups, and sprays. The key with any of them is to stick to the dose and schedule that your doctor sets. Your child may need regular blood tests and EEGs to make sure the medicine works as expected.

Side effects may include rashes, having more body hair than normal, and weight changes. They can also cause more serious problems, like liver or bone issues. If that happens, you move on to a different drug.

About 1 in 4 kids stop having focal onset seizures when they get older. So if your child goes 2 years without one, your doctor may suggest slowly lowering the dose and then stopping it entirely.

If drugs don't work or the side effects are too much, your doctor may suggest this high-fat, low-carb diet. It focuses on foods like cheese, butter, and oils instead of bread, fruit, and pasta. Doctors don't know why it works, but when it's successful, it can stop seizures entirely.

It's a strict and complicated diet. To see if it can work, your child has to follow it very closely. They'll start the diet in the hospital during a stay of several days. You'll both learn about what foods to eat and how much of them.

Typically, kids stay on the diet for 2 years, though some do it much longer. Keep in mind that while this may seem like a more natural approach, it can still have side effects and doesn't always work.

It's rare for a child to get surgery, and it's usually not the first choice of treatment, but it's an option if:

  • Doctors can locate where in the brain the seizures happen, and the operation won't damage that area.
  • Drugs haven't worked.
  • The seizures won't likely get better with age.

It's also needed when a brain tumor is the problem.

The goal of surgery is to take out or disconnect the part of the brain causing seizures. It's complex, but it's gotten much more common as imaging and EEGs have improved. Doctors can now pinpoint the exact part of the brain that's leading to issues.

Since the brain doesn't feel pain, your child may be awake during it. This allows doctors to have your child do simple tasks to make sure they're on the right path.

This treatment is most common in kids over age 12 who have focal onset seizures that medicine can't control. The vagus nerve starts in the brain and runs far and wide throughout the body. It has a hand in everything from swallowing to how your lungs work.

The idea behind VNS is to control seizures by sending small electrical signals through the vagus nerve to the brain. Your child gets surgery to place a small battery-powered device in the chest. It's programmed to send signals every few minutes.

Your child will also get a magnet that acts as a switch to turn the device on. If your child feels a seizure coming, they can hold it over the device to get the signals pulsing. This may stop the seizure or at least shorten it.

Side effects can include voice changes, as well as pain or hoarseness in the throat. Also, the battery lasts about 6 years. After that, your child would need another surgery to replace it.