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Treatment Options for Children with Epilepsy Treating Epilepsy: From Drug Therapy to Surgery

Epilepsy Current Topics in Epilepsy

The State of Surgical Therapy in Epilepsy

Summary & Participants

Children whose epilepsy is not controlled through medications may want to consider alternatives. Learn about one option that is growing in popularity.

Medically Reviewed On: January 11, 2005

Webcast Transcript

ANNOUNCER: Epilepsy affects approximately 2.5 million people in the United States, of which an estimated 300,000 are children under the age of 14. Although most children are able to achieve seizure control through the use of anti-convulsant medication, some can develop what's known as refractory or medication-resistant epilepsy. These children are unable to gain seizure control through the use of medication and must look to alternative treatments. One such alternative is brain surgery.

Although the risks and benefits of any surgical procedure need to be discussed thoroughly, this is especially true when it comes to pediatric brain surgery.

HOWARD WEINER, MD: The evaluation procedure for a child being considered for epilepsy surgery is very intense. All of the information, based on the imaging, the MRI scans, the functional imaging, such as PET scanning, SPECT scanning, MEG, are all considered. The clinical features and the EEG data are all put together, are discussed at a comprehensive conference, and a surgical plan is derived for that particular child.

After that's done, we sit down with the family, and we discuss the potential risks and benefits, what we think will be expected with this surgical approach, and the family really makes a decision about whether they want to go ahead.

ANNOUNCER: If an agreement is reached that surgery will be beneficial to the child, there are a variety of surgical techniques currently being performed.

HOWARD WEINER, MD: The traditional approaches, brain surgery or craniotomy, where the brain is actually removed, the seizure focus is identified using a variety of techniques, and if this can be done safely, this area of seizure focus is removed safely.

There are also techniques that involve neurostimulation, most commonly known as vagal nerve stimulation, which is a device that is implanted around the vagus nerve in the neck, attached to a generator, and delivers a certain current to the vagal nerve, which has a broad connectivity with the rest of the brain. And that has an ability to control seizures as well.

And there's a procedure called corpus callosotomy, which is done in the center of the head where the corpus callosum, a fiber bundle that connects the right and the left side of the brain is severed and that is done to prevent the rapid spread of seizure activity and to really help with these drop attacks. So that's also done more or less as a palliative procedure in children with this type of epilepsy.

ANNOUNCER: Pediatric brain surgery for epilepsy is most effective in children who fit three main criteria.

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