Your child’s brain contains millions of cells called neurons. Neurons send electrical signals throughout the body to help your child think, move, and speak. In children with epilepsy, these signals are disrupted, which results in seizures.
Children with epilepsy typically take medicine to help control seizures. However, in about 30% of these children medication alone is not effective. Also, some children have a clear structure cause of their epilepsy like a tumor or focal cortical dysplasia. When medicine doesn’t control epilepsy or seizures are the result of a clear structural abnormality in the brain, pediatric epilepsy surgery may be an option.
How Do Doctors Treat Epilepsy in Children?
Usually, doctors prescribe antiseizure medicine to treat a child’s seizures. One antiseizure drug may stop your child’s seizures for a while. But sometimes, it doesn’t work, doesn’t stop all seizures, or stops working after some time.
The doctor may then prescribe a different type of antiseizure medicine. The new medicine may help, or it may not work at all. It may also work at first and stop working after some time.
When your child has tried two different medicines and still doesn’t have effective, long-lasting control over their seizures, doctors label their condition as drug-resistant. Pediatric epilepsy surgery may be the next step for children with drug-resistant epilepsy.
Talk to your child’s doctor when medicine doesn’t control their seizures or when your child’s seizure is caused by a structural abnormality. They may suggest looking into surgical treatment of seizures. The first step is a pediatric epilepsy surgery preoperative assessment.
What Is Surgery For Epilepsy in Children?
There are many types of surgery for epilepsy in children. Surgery helps kids with drug-resistant epilepsy.
Some types of noninvasive and less invasive surgeries can treat epilepsy in surgery. They include laser surgery for epilepsy and implanted devices to control the electrical activity in the brain.
They may have brain surgery, including removing the part of the brain where a child’s seizures start. Other types of pediatric epilepsy surgery disconnect parts of the brain to help stop or control seizures.
How Will I Know If Epilepsy Surgery Can Help My Child?
To find the best surgical option for your child with epilepsy, doctors use tests. They help determine what causes seizures and where they originate in your child’s brain. They use this information to recommend the best surgery for your child.
During diagnostic evaluation for epilepsy surgery, your child may have brain mapping tests.
These tests include:
- Electroencephalogram (EEG) — This painless test measures electrical activity in your child’s brain.
- Magnetoencephalography (MEG)—This test helps doctors find problem tissue areas deep within the brain that may cause seizures. It is non-invasive, and your child won’t feel pain.
- Magnetic resonance imaging (MRI) — This scan creates detailed images of the brain using powerful magnets and a computer.
- Stereoelectroencephalography (sEEG) using robotic stereotactic assistance (ROSA®) — sEEG involves robotic implantation of electrodes into the brain to create a 3-D recording of how seizures spread in the brain. To do this, surgeons use ROSA and make tiny holes in the skull and precisely place electrodes. They use a computerized system to map where seizures occur in your child’s brain and plan their epilepsy surgery.
- Single photon emission computed tomography (SPECT) — This test tells doctors how blood flows inside your child’s brain. It also helps doctors determine where seizures occur.
Types of Pediatric Epilepsy Surgery
Brain surgeons, also known as neurosurgeons, use different techniques and surgical procedures to treat epilepsy in children.
Brain resection
A surgeon creates an opening in the skull. They access brain tissue through the opening and remove tissue that causes seizures. This is the most common type of surgery for epilepsy in children.
Your child may have:
- Lesionectomy — Surgeons remove damaged brain tissue (lesions) that can cause seizures.
- Lobectomy — Surgeons remove a specific area within the brain (lobe) where seizures occur.
Corpus callosotomy
Experts disconnect the connection between the left and right sides of the brain. This is a piece of brain tissue called the corpus callosum. A corpus callosotomy disconnects the two sides of the brain to change how electrical signals travel. Disconnection surgery can help your child have fewer or less severe seizures.
Hemispherectomy and hemispherotomy
Surgeons may use hemispheric surgery when seizures occur in only one half (hemisphere) of the brain. Doctors disconnect half of the brain’s outer layer from the other half so electrical signals can’t travel to the other side of the brain and cause seizures.
Laser ablation for pediatric epilepsy
Surgeons may treat your child with laser interstitial thermal therapy (LITT), also known as laser ablation. They use a laser to apply heated energy (thermal energy) to the part of the brain where seizures begin. The heat destroys the brain tissue, causing seizures.
Device implantation
Surgeons make small openings in your child’s skull to implant electrodes or devices that control electrical signals in the brain.
Implanted devices that can treat epilepsy in children include:
What Age Can a Child Have Epilepsy Surgery?
A child may have pediatric epilepsy surgery at any age. The most important factor doctors consider is how many medicines your child has tried to control seizures.
They also consider the type of seizures your child has and where they begin in the brain. To be a candidate for surgery, your child’s seizures must be in a part of the brain that surgeons can remove without affecting speech, movement, or vision.
Recovery After Epilepsy Surgery
Your child’s surgeon will tell you what to expect as your child recovers from epilepsy surgery. If doctors make an opening in the skull (open surgery), your child may stay in the hospital for a few days.
Your child may experience some discomfort right after surgery.
They may have:
- Fatigue.
- Headache.
- Nausea.
- Swelling in the face.
If they recover well, most children return to school about 4 to 6 weeks after surgery. Talk to your doctor about what to expect as your child recovers from surgery.
Is Epilepsy Surgery Right for My Child?
Talk with your doctor about whether epilepsy surgery is a treatment option for your child. Surgery can stop seizures or help your child have fewer seizures. It can also reduce the need for seizure medicines.
However, surgery has some risks. Talk to your doctor about how surgery could affect your child’s ability to move and talk.
Can Surgery Cure Epilepsy?
Surgery can cure epilepsy but not always. Doctors consider epilepsy surgery a success if a child is free from seizures or has seizures rarely. More than half of children who have epilepsy surgery remain free from seizures 10 years after surgery, according to research published in the journal Seizure.
The results of surgery may vary depending on the following:
- The type of epilepsy surgery your child has.
- Where seizures occur in your child’s brain.
Talk to your doctor if your child has seizures after trying two different medicines. Epilepsy surgery may be the best treatment to stop or reduce seizures.
To schedule an appointment or a consultation with the Pediatric Epilepsy Center at UPMC Children’s Hospital of Pittsburgh, call 412-692-6928.
Sources
Brain Facts.org, How Neurons Communicate, Link.
Child Neurology Foundation, Epilepsy, Link.
Epilepsy Foundation, Drug Resistant Epilepsy, Link.
Epilepsy Foundation, Epilepsy Surgery for Children, Link.
Epilepsy Foundation, Recovering After Epilepsy Surgery, Link.
Epilepsy Foundation, Who Can Epilepsy Surgery Help? Link.
InformedHealth.org, Epilepsy: Learn More — Epilepsy in Children: Types and Treatment Options, Link.
MedlinePlus, Epilepsy in Children, Link.
National Institute of Neurological Disorders and Stroke, Epilepsy and Seizures, Link.
UPMC, Pediatric Epilepsy Surgery Program at UPMC Children’s Hospital of Pittsburgh, Link.
UPMC, Types of Pediatric Epilepsy Surgery, Link.
Harris, W. B. et al. (2022). Seizure. Long-term outcomes of pediatric epilepsy surgery: Individual participant data and study level meta-analyses. Link.