One possible option for some children with epilepsy is surgery. You may be frightened by the idea of your child having brain surgery, a treatment reserved for a select few, but 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 the skull and place a grid of plastic embedded with electrodes on the brain. The electrodes then monitor the brain's electrical activity. This test may help determine the focal point of your child's 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 reduced.
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.
Epilepsy and Vagal Nerve Stimulation (VNS)
VNS is a newer type of treatment for people with seizures who haven't had success with medication and are not candidates for epilepsy surgery. In some ways, it's conceptually similar to a pacemaker for people with heart problems. VNS involves implanting a small device about the size of a silver dollar in the chest. It is attached by small wires under the skin to the vagus nerve, a large nerve in the neck, and programmed to regularly emit pulses of electricity to the nerve every few minutes.
Exactly why the device works isn't entirely known, but these regular pulses of electricity help reduce the frequency or intensity of seizures. The device can also be triggered manually by a magnet that can be worn on the wrist or belt. If a person feels a seizure coming on, he or she can wave the magnet over the device to cause it to immediately deliver an electric charge. Parents could also use the magnet on their child after a seizure has begun.
The most common side effect of VNS is hoarseness and, less commonly, discomfort. It may also cause a person's voice to change during the few seconds of stimulation (for that reason, people sometimes turn it off before singing or public speaking). A doctor will be able to reprogram the device in the office using a computer, and you shouldn't need any further maintenance until the battery runs out, which will probably be about six to eight years.
VNS doesn't cure epilepsy but, like anti-seizure medicines, in most people it helps reduce symptoms. Usually, a person using VNS would still take medication, although probably in smaller doses.
The Future of Epilepsy Treatment
"Obviously, we want a cure," says Turk, "but we just don't have one yet. The closest thing we have to a cure for children is the hope that they will go into remission on their own as they get older."
But while a cure for epilepsy isn't imminent, progress in treatment is making a difference. Turk is optimistic that the increased money for epilepsy research in recent years will bring success. Advances have already been made in the development of new technology to treat epilepsy and assist in the surgical evaluation.
Some other promising work has been in the genetics of epilepsy. Researchers are beginning to learn how different types of the disease are inherited. Eventually, a better understanding of genetics could lead to more targeted and more effective treatments for the different varieties of seizures.
Solomon Moshe, MD, director of child neurology and clinical neurophysiology at Albert Einstein College of Medicine in Bronx, New York, says one big leap in treating childhood epilepsy will be the development of drugs that are specifically designed for children. Because it's harder to research medicines in children, kids with epilepsy wind up getting drugs that are designed for adults. Researchers are confirming that childhood epilepsy is significantly different from adult epilepsy. The next step is to make drugs specifically for children.
Turk is excited about the possibility of improving the treatments we already have. "One of the most exciting things in epilepsy treatment is that we now know that if we treat a person very carefully, we get a much better outcome," he says. "We don't have to settle for just getting close to controlling the condition."
"There's no magic bullet yet," Turk continues. "But treatment of epilepsy in children is now phenomenally better than it was ten years ago. And I know that in another ten years, it will be better still. That's where the hope lies."