Epilepsy Surgery for Children
Epilepsy Surgery in Children
Some children with refractory (also called drug-resistant) epilepsy may be candidates for epilepsy surgery. In a child with focal epilepsy (seizures coming from one specific area in the brain), their chance of becoming seizure free after being on two antiseizure medications at optimal dosing is less than 5 to 10%. All children are different, however. Depending on the specifics of the child, in general, the chances of being seizure free after epilepsy surgery may be between 50 and 80% in children.
Epilepsy surgery in many children is similar to many of the surgeries available for adults with drug-resistant epilepsy.
- However, particularly in younger children, resections are often more extensive. This means that larger areas of the brain may need to be operated on. Children may undergo a focal resection, hemispherectomy, or corpus callosotomy.
- A vagus nerve stimulator (VNS) may also be used to help control seizures. VNS Therapy® is approved by the U.S. Food and Drug Administration (FDA) for use in children greater than 2 years of age.
- RNS (responsive neurostimulation) and DBS (deep brain stimulation) are not yet FDA-approved in children but may be used in special circumstances.
The Effects of Frequent Seizures
Research shows that the earlier a child has epilepsy surgery, the better the outcome of their epilepsy and their cognition (ability to think and understand). When a child’s brain is repeatedly exposed to seizures over time, the brain can undergo changes that lead to even more seizures. This can make it harder to stop seizures with medications.
- Frequent seizures can lead to changes in a child’s cognition or thinking abilities, motor development, and social development.
- The child may develop learning disabilities from having so many seizures.
- When a child has developmental problems because of their epilepsy, it is referred to as an epileptic encephalopathy.
- This is why doctors try to stop seizures with medications, surgery if appropriate, and dietary therapies.
Families Share Their Stories
An example of an epileptic encephalopathy is a condition called West syndrome. This typically occurs during infancy. The child has recurrent brief seizures called spasms. Their brain waves look very disorganized and the child stops making developmental progression and may regress.
"Shortly after surgery, it was like a light switch turned on – Mother of a child following a hemispherectomy for intractable epilepsy"
"She was able to make far more connections that she could remember and express," the mother continues. "Considering brain surgery for your child is a very intimidating decision. With that being said, I wish I could have known the amount of cognitive progression she was missing out on before surgery. I can now see the future of independence that she deserves and will achieve!"
Check out this interview with Megan about her son Anthony, their family's life with epilepsy, and how they decided surgery was the right treatment option for Anthony.
Learn from Reagan and his mom Stephanie about how how surgery helped him get on a path to seizure freedom and lead his family to become epilepsy advocates.
Recovery After Surgery
- Sometimes children have surgeries that affect eloquent cortex. This refers to parts of the brain that may affect the function of their arms, legs, or speech.
- Children who have these surgeries at young ages are less likely to develop long-term problems. This is because young brains can re-wire to a certain extent.
Long Term Effects of Medication on the Brain
- Children who have epilepsy surgery are often able to stop using seizure medicine or are able to use less medicine over time, compared to children with drug-resistant epilepsy who do not have surgery.
- Many antiseizure medications, especially when more than one is used, can affect a child’s thinking, attention, and behavior.
Children with drug-resistant epilepsy may be good candidates for epilepsy surgery, especially if a focal cause (specific location in the brain) of their seizures is found. However, this is a specialized treatment and needs to be tailored to each child.
Epilepsy surgery is not for all children with epilepsy. For example, children with generalized epilepsy syndromes are not candidates for resective epilepsy surgeries. However, they may be candidates for surgeries such as corpus callosotomies or vagus nerve stimulation.
If your child has seizures not controlled by medicine, talk to your child’s pediatric neurologist.
"Ask if he or she is a candidate for surgery or other treatments."
Surgery for children with epilepsy is done at a level 4 epilepsy center, using the accreditation designations for epilepsy centers from the National Association of Epilepsy Centers. A level 4 center provides the full range of services to diagnose and treat people with epilepsy, including all types of epilepsy surgery.
Watch our Webinar, "An Overview of Pediatric Epilepsy Surgery
- Nancy McNamara MD, Pediatric Epileptologist and Assistant Professor of Neurology at the C.S. Mott Children’s Hospital, University of Michigan, in Ann Arbor, MI
- Megan Middaugh, Eastern Iowa Program Coordinator at the Epilepsy Foundation Iowa and Epilepsy Coordinator at the University of Iowa Hospitals and Clinics in Iowa City, Iowa
- Elaine Kiriakopoulos, MD, MSc, director of health communications and engagement for the Epilepsy Foundation
Recorded July 24, 2019
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