Epilepsy Treatment

Pediatric Epilepsy Treatment

What are the recent advances in pediatric epilepsy surgery?

We have made remarkable advances in the field of pediatric epilepsy surgery.  Some of these advancements include the following:

• Early recognition of drug resistant epilepsy by subspecialty-trained pediatric neurologists
• Advanced imaging techniques that help identify the origin of epileptic seizures by expert pediatric neuro-radiologists
• Detailed neurocognitive evaluations that can help quantify risks and counsel patients being considered for surgery by dedicated pediatric neuropsychologists
• Access to state-of-the-art equipment, including minimally invasive options, to expert pediatric neurosurgeons dedicated to the treatment of epilepsy

With access to the latest technology and expertise across each of the disciplines involved in pediatric epilepsy surgery, excellent seizure outcomes can be achieved with the least probability of causing any neurological damage as a result of the treatment.  Interestingly, the most utilized seizure outcome classification tool is named the ‘Engel Scale’, named after a renowned UCLA neurologist, Dr. Jerome Engel Jr.

What if surgery is not an option?
In some instances, the team may determine that seizures are arising from multiple areas of the brain, from the entire brain or the risk of removing the areas causing the seizures are too high.  Under these circumstances, there are options for palliative surgical treatments such as a Vagal Nerve Stimulator (VNS) or a Responsive Neurostimulation (RNS) Device.  These devices do not completely eliminate seizures but can greatly reduce the frequency and intensity of seizures.  There are also non-surgical experimental therapies that can be tried.

The VNS generator is implanted under the skin at the chest and sends signals to the brain through electrodes that are attached to a nerve in the neck.  Although the exact mechanism of action is unknown, it is thought to disrupt brain signals from synchronizing.  This is a process known to result in seizures.

The RNS device is currently only approved for routine use in adults.  The device is implanted in the skull.  It detects the early phase of a seizure formation and transmits electrical impulses directly to a specific area of the brain in an attempt to disrupt seizures from originating and propagating. Both the VNS and RNS devices have similar effectiveness.  They generally lower seizure frequency by about 50% in half of all patients using this device.