January 12, 2022

When to consider epilepsy surgery for your child

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If medications aren’t controlling your child’s seizures, surgery could help.

If your child has epilepsy, medication is generally the first line of defense for controlling seizures. But if medications aren’t helping, then surgery for epilepsy may be a good treatment option to help gain better seizure control. In some cases, epilepsy surgery may even help your child be free from seizures altogether.

“Epilepsy surgery has been around for a long time,” said Robert Naftel, M.D., a pediatric neurosurgeon with Monroe Carell Jr. Children’s Hospital at Vanderbilt Neurosurgery. “There’s been a lot of research done on epilepsy surgery, and it’s been found to be highly effective in treating epilepsy, especially in children who have failed two medications.”

When to consider surgical treatment for epilepsy

About 70% of children with epilepsy will do well on medication. “They can take one antiepileptic and get good control of their seizures,” Naftel explained. “But 30% is still a big number of children who don’t have success with one medication.” When that happens, about 5% of those patients may do well with the addition of a second prescription, Naftel added.

However, if two medications together do not work, a third is unlikely to provide relief. “Once you have failed two medications,” Naftel said, “we typically like to start considering surgery because certain surgeries may have a higher likelihood of giving good seizure control.”

Types of epilepsy surgery

The type of surgery that may be a good fit for your child will depend on several factors, including the type of epilepsy your child has. “Epilepsy surgery is not one-size-fits all,” Naftel explained. “We really have to individualize treatment to each child.”

First, your child will undergo some initial testing to help determine where in the brain the seizures originate. In some instances, a minimally invasive procedure is required to pinpoint the location.

If your child has focal epilepsy, in which the seizures originate from just one place, then surgery may involve removing that area, as long as doing so would be safe. “The goal of such a surgery would hopefully be a cure of their epilepsy and to gain seizure freedom,” Naftel said. “It’s reasonable to consider that perhaps, in the long run, they’d be able to come off of their seizure medications.”

Sometimes targeting the area can involve a minimally invasive procedure that uses a laser to ablate or destroy tissue. In other cases, when working with a larger section, the procedure may require a more invasive technique or even the removal of a lobe.

Your child may not have a type of epilepsy that can be cured completely. But surgery might still be a good epilepsy treatment option for providing significantly better seizure control than with just medications alone.

Some children have multi-focal epilepsy with “drop attacks,” where their head or body goes limp. “We might do a corpus callosotomy,” Naftel said, “where we disconnect one of the main pathways between the two sides of the brain to slow down the spread of the seizures.”

Another option might be a vagus nerve stimulator. In this procedure, a surgeon implants a small electrode in your child’s neck that will stimulate a nerve via a device. The stimulation can help reduce seizures and improve quality of life, Naftel explained.

A team effort

If your child is a candidate for epilepsy surgery at Vanderbilt, a team of care providers will collectively help decide on the best course of action based on testing and examination results.

“All that data we have collected is presented in a multidisciplinary epilepsy conference including all of the epileptologists, radiologists, other team members, and myself,” Naftel said. “And we present a child’s epilepsy story and test results and then discuss it as a group to determine the best option.”

Need help?

Monroe Carell Jr. Children’s Hospital at Vanderbilt brings together multiple experts in pediatric neurology, pediatric neurosurgery, pediatric neuroradiology, psychologists, dieticians, pharmacists and nurses, all working to care for patients not just as those with epilepsy but as whole children. The Comprehensive Epilepsy Clinic offers expertise in difficult-to-treat seizures and comprehensive epilepsy management, including medications, diet and surgical options tailored to each child.

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