Treating Children’s Epilepsy

Epilepsy is a highly treatable condition that can be effectively treated with medication in between 70 and 80 percent of children. 

If your child has epilepsy, treatment options vary depending on the type of epilepsy he or she has, the severity of the symptoms, the effectiveness of different medications, and your child’s tolerance for medication side effects. Treatments for epilepsy range from medication to surgery and other procedures, such as vagus nerve stimulation (VNS). 

If your child has epilepsy, he or she will need treatment. Fortunately, there are many different treatment options, and treatment tends to be quite effective at controlling seizures.

Your child’s doctor will work with you and your child to come up with a treatment plan that works best to stop seizures and address any related cognitive or physical effects of epilepsy. Your child may need to see more than one specialist to get the most out of treatment. Beaumont’s Pediatric Comprehensive Epilepsy Center offers comprehensive epilepsy care from a multidisciplinary team of specialists.

Common epilepsy medications

There are several medications used to treat epilepsy. Researchers are developing new medications and looking for ways to adjust medical treatment so it’s most effective for various types of epilepsy. Because of this, doctors are becoming better at finding the best medications for children with epilepsy. There are approximately 20 medications currently approved by the FDA for treating epilepsy in children. If your child has epilepsy, talk with his or her doctor about what your child’s medication options are and what the pros and cons for each medication may be.

The most common drugs for pediatric epilepsy are:

  • Carbamazepine (Carbatrol, Tegretol)
  • Phenytoin (Dilantin)
  • Valproic acid (Depakene, Depakote)
  • Ethosuximide (Zarontin)
  • Felbamate (Felbatol)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Levatiracetam (Keppra)
  • Oxcarbazepine (Oxteller XR, Trileptal)
  • Tiagabine hydrochloride (Gabitril)
  • Topiramate (Topamax)
  • Zonisamide (Zonegran)
  • Lamotrigine (Lamictal)

Common side effects of these medications include:

  • Nausea
  • Sleepiness
  • Vision disturbances, like double vision
  • Dizziness
  • Unsteadiness
  • Rash

Phenytoin is also known to have the potential to cause excess hair growth.

Epilepsy medication must be taken every day as prescribed in order to work effectively. Most anti-epileptic medications should be taken twice per day, but there are some that can be taken once a day and some that must be taken three or four times per day. 

Surgery for diagnosis and treatment of epilepsy

When anti-epileptic medications don’t work or your child has severe side effects when taking medications, your child’s doctor may recommend other treatment options, such as diet changes, surgery, or vagus nerve stimulation (VNS).

Diet Therapies – Some children have success controlling seizures by eating a ketogenic diet. This type of diet restricts carbohydrates, so foods like bread and pasta will not be allowed. If your child’s doctor recommends this diet, your child will have to work with a trained, registered dietician to ensure your child gets proper nutrition while restricting certain foods.

Vagal Nerve Stimulation (VNS) – VNS is a treatment option for some children with epilepsy. During VNS, the doctor will place a device in the chest that connects via a wire to the vagus nerve in the neck. The device stimulates the vagus nerve, which in turn stimulates the brain. The goal of VNS is to decrease seizure activity. VNS requires a surgical procedure to place the device, so it will not be offered unless medications don’t work or your child can’t tolerate them. Many doctors will offer VNS in addition to medication if the medications are partially effective but aren’t completely stopping seizures. 

The vagus nerve stimulator (VNS) is a device that regularly sends out electrical signals to the brain. Doctors often use VNS in children whose seizures come from multiple sources and thus are not candidates for traditional epilepsy surgery. 

The VNS works by sending electrical signals to the brain via the vagus nerve, which interrupts the spread of a seizure. The vagus nerve sends signals from the body to the brain, and the VNS works with the vagus nerve to send signals to the brain.

Stimulating the vagus nerve can help reduce seizures, both in number and severity if they do occur. About one-third of patients have a 30 to 50 percent reduction in the number of their seizures, and many children experience reduced severity of their seizures. A few patients become seizure free.

Placing the VNS requires general anesthesia. And after surgery, patients must have multiple appointments to turn the device on and adjust strength of stimulation.

Epilepsy surgery – When seizures originate in one part of the brain, neurosurgeons who specialize in epilepsy will sometimes remove the affected part of the brain in an attempt to stop seizures. Epilepsy surgery that removes brain tissue is meant to be a curative procedure that will allow the child to completely stop taking anti-epileptic medication. 

If your doctor thinks surgery may be an option, he or she will do a thorough evaluation to ensure it’s the right choice. Surgery will not be used unless anti-epileptic mediation therapy has failed, and it is usually reserved for children who have frequent and uncontrollable seizures that cannot otherwise be managed. Seizures must also start in one area of the brain and be caused by scar tissue or a tumor, cyst, or other lesion that can be removed through surgery.

If your doctor has recommended epilepsy surgery, consider getting a second opinion. It’s important to take your child to a surgeon who has expertise and significant experience in this type of procedure. It’s also important to weigh the risks of continued seizures against the risks of surgery before deciding surgery is the right choice for your child.

Surgical procedures for pediatric epilepsy

There are several types of epilepsy surgery available, including:

  • Resection – During this procedure, the surgeon removes the part of the brain that is the source of the seizures while preserving nearby brain tissue necessary for functioning. Computer-assisted neuronavigation and intraoperative electrode recordings help improve the safety and efficacy of this procedure.
  • Ablation – Ablation is a minimally invasive procedure that destroy lesions on the brain that are causing epilepsy. Like resection, doctors use neuronavigation for improved safety and efficacy.
  • Laser interstitial thermal therapy (LITT) – This surgery involves drilling a hole in the skull at the back of the head and navigating (with guidance from MRI) to the area causing the seizures, then using a laser to destroy the affected tissue. 
  • Corpus callosotomy – Rarely, surgeons may perform a procedure to disconnect the right and left hemispheres in an effort to stop seizures from spreading between brain hemispheres. This may help protect some children from injuries related to falls during seizures. However, this surgery doesn’t prevent seizures and may actually increase certain types of seizures. It may also cause limitations in speech or movement and lead to behavior changes, so it’s not used very often.
  • Hemispherectomy – This surgery involves removing most or part of one half of the brain and disconnecting it from any portion remaining on the other half. This is not a common procedure, and most hospitals don’t perform it. It is only used for children who have the most severe cases of epilepsy stemming from an abnormal brain hemisphere. While it seems like an extreme treatment, it may be the only option for successful treatment.

If your child has epilepsy, he or she will need treatment. Fortunately, there are many different treatment options, and treatment tends to be quite effective at controlling seizures.

Pediatric epilepsy care at Beaumont

At some point during treatment, you may want to take your child to an epilepsy specialist (an epileptologist). Beaumont has several pediatric epileptologists who work at the Pediatric Comprehensive Epilepsy Center. Call 248-551-6178 today to make an appointment for your child. 
The Comprehensive Epilepsy Center at Beaumont Children's offers a range of pediatric epilepsy treatment and monitoring services for infants, children, and teens who have epilepsy or have experienced seizures. Our clinic offers comprehensive seizure evaluations and diagnostic tests for all forms of epilepsy, including MRIs, PET scans, and EEGs.

Doctors Daniel Arndt, M.D. and Pramote Laoprasert, M.D. are pediatric epileptologists who lead the center, which specializes in helping young patients with drug-resistant epilepsy. About one-third of patients who have severe epilepsy will not respond to medication and will need additional treatment.

The multidisciplinary staff at the Comprehensive Epilepsy Center is made up of highly trained specialists, including pediatric neurologists, epileptologists, pediatric neuroscience nurses, pediatric EEG technologists, and a nurse coordinator. Using some of the most advanced EEG and imaging technologies available, our team works closely with Beaumont experts in several specialties, including pediatric neurosurgery, ophthalmology, radiology, and physical, occupational, and speech therapy.

The Comprehensive Epilepsy Center provides resources and guidance for parents and caregivers in a single location, giving them comfort and predictability during a challenging and sometimes unpredictable time.

The Pediatric Comprehensive Epilepsy Center at Beaumont Children’s is accredited by the National Association of Epilepsy Centers as a Level 4 epilepsy center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

Call us today

If your child has had a seizure or has been diagnosed with epilepsy and you’d like to see one of our specialists, we’re here to help. We are located in the Neuroscience Center in Suite N120 on the campus of Beaumont Hospital, Royal Oak. To schedule an appointment or learn about Beaumont's pediatric epilepsy services, call 248-551-6178.

For a referral to a Beaumont pediatric epilepsy specialist, call 855-480-KIDS (855-480-5437).