The type of seizures your child has helps doctors suggest the best course of treatment. For your child, the best treatment may be medicine, surgery or a combination of the two.
Frequent, uncontrolled seizures that are not helped by medicine can be harmful to your child. They can interfere with normal development and learning. They can even permanently damage a child’s developing brain. For some children, some medicines for epilepsy cause side effects they can't tolerate. Or, the medicine may interfere with normal learning and development. If medicine does not control your child’s seizures, your child's neurologist may refer them for a neurosurgery evaluation.
Surgery for Epilepsy
Our neurologists and neurosurgeons work with you to find the best treatment for your child. We think about several factors when deciding if your child is a good candidate for surgery. Children may benefit from surgery if they have:
- Ongoing seizures even though they take or have taken anti-seizure medicine
- A known, specific area in their brain, called a focus that causes seizures.
- Affected tissue in the focus area that can be removed safely. Surgery is designed to avoid damage to speech and movement.
- Intolerable side effects from medicine
Mesial temporal sclerosis (scar of brain tissue has been removed)
The surgeries we do to help children with epilepsy include:
Temporal lobectomy
A temporal lobectomy is the most common epilepsy operation for adults and teens. We consider this surgery if your child has a small, non-cancerous (benign), slow-growing tumor in the part of the brain called the temporal lobe. We also consider using it if your child has abnormal brain tissue (mesial temporal sclerosis or cortical dysplasia).
Often, we can control your child's seizures by removing the affected area. If necessary, the neurosurgeon may remove the entire temporal lobe. This surgery stops seizures in 50% to 70% of carefully chosen patients. Another 10% to 20% of patients may have better seizure control, although seizures don't go away entirely.
Resection of epileptic focus (outside the temporal lobe)
In some cases, we can remove (resect) the tissue causing the seizures. This is possible if your child’s seizure focus is in a particular area of the brain only and that area is not necessary for functions like speech or movement.
After the scar and the seizure focus is surgically removed
Before this operation, doctors must find the focus of seizures in your child's brain. They must also map the areas of your child's brain that control functions like speech and movement.
Your child may have surgery to place electrodes on the surface of the brain. Doctors monitor your child for about a week in Seattle Children’s video and EEG monitoring unit. The neurosurgeon and neurologist can then plan to remove the area of your child's brain that is affected.
The electrodes also help doctors map out the parts of your child's brain that control speech and movement. Sometimes, we can map a teenager's brain during surgery. During this procedure we wake your teen up and ask them to help us with the mapping.
If our findings show that your child is a good candidate, we operate. After this operation, 50% to 65% of carefully chosen patients have either many fewer seizures or no seizures at all.
Hemispherectomy/Hemispherotomy
Both of these surgeries treat seizures caused by an entire side (hemisphere) of the brain area that controls many complex processes – the cerebral cortex.
Many medical centers, including Seattle Children’s, no longer remove the tissue that causes these seizures. Instead, we disconnect the tissue in a procedure called functional hemispherectomy. The terms functional hemispherectomy and hemispherotomy describe different versions of the surgery. In general, this type of operation is shorter and causes fewer complications than older versions.
To understand the procedures, it helps to know that the brain has two halves, the right and left hemispheres. Two groups of children with epilepsy may benefit from either a hemispherectomy or hemispherotomy:
- Children with many seizure focus areas located throughout one hemisphere of the brain
- Children whose areas of seizure focus are spread throughout the entire hemisphere
These surgeries may benefit children with:
- Sturge-Weber syndrome
- Rasmussen's encephalitis
- Hemimegalencephaly
- Extensive cortical dysplasia
- Extensive porencephalic cysts
During surgery, your child's neurosurgeon disconnects the affected hemisphere from the rest of the brain by cutting the electrical nerve pathways. The goal is to prevent seizure activity from spreading. Afterward, about 70% of carefully selected children may be seizure free. About 20% may have fewer seizures.
Sometimes, a child's brain function will move to the healthy side of the brain before or after surgery. If important parts of their brain must be cut, children experience notable changes.
After surgery, your child may be weak on one side. This weakness may be permanent. As a result, we limit this operation to children who:
- Have severe seizures that greatly limit quality of life
- Are already weak on the affected side because of the underlying brain illness, such as a stroke
After surgery, most children need to stay in the hospital for rehabilitation. This helps them improve or manage weakness.
Corpus callosotomy
The corpus callosum is a bundle of fibers connecting the right and left sides (hemispheres) of the brain. A corpus callosotomy involves cutting this bundle to prevent seizures from spreading from one hemisphere to the other. Neurosurgeons do this by cutting the front (anterior) two-thirds of the corpus callosum.
This surgery may be helpful if your child has seizures that do not involve a specific area of brain tissue that we can remove. Often, it helps children who have "drop attack" seizures. That is, the child’s muscles suddenly contract and they fall down or collapse forward in a chair.
After surgery, about 70% to 80% of children may have fewer drop attack seizures. If your child's seizures aren't reduced enough, sometimes neurosurgeons recommend a second operation.
Vagal nerve stimulator
Some children are not candidates for epilepsy surgery because:
- Their seizures begin in several brain areas (they have multiple foci)
- Their seizures spread (generalize) to both sides of the brain
- After trying several medicines, they still do not have good seizure control.
The vagal nerve stimulator is an alternative to brain surgery.
The vagus nerve starts in the brainstem. From there it goes down the neck and into the chest. The vagal nerve stimulator delivers a small, on-and-off electrical current to the vagus nerve. This helps prevent seizures.
The vagal nerve stimulator is about the size of a small cookie. Neurosurgeons put it under the skin on the left side of your child’s chest, near the armpit.
During surgery, your child's neurosurgeon puts in (implants) the stimulator. The neurosurgeon moves wires attached to the stimulator to the left vagus nerve, in the neck region. After the area heals, your child's neurologist turns on and sets the device.
Both you and your child can turn on the vagal nerve stimulator yourselves. If your child senses the start of a seizure, you can place a small, hand-held magnet over your child’s body at the spot where stimulator is located. This can prevent the seizure from starting.
Doctors don’t know exactly how the stimulation affects a child’s seizures. But about half of people with a vagal nerve stimulator reduce their seizures by more than 50%.
The vagal nerve stimulator is approved for use with patients 12 years old and older. Its battery needs changing every several years.
Other Epilepsy Treatment Options
Neurologists sometimes use the ketogenic diet to lessen or stop a child’s seizures. In general, it includes eating foods high in fat and low in carbohydrates and protein. It also limits the amount of liquid your child can drink.
Ketogenic diet is very complex. Children on it should always be under a doctor's care. To learn more about how the ketogenic diet works, please talk to your child’s neurologist.