In some cases, children with epilepsy may not respond to treatments using medication and require surgery to reduce or eliminate the seizures they experience. In cases like these, there are a number of surgeries that can help.
The surgeries best suited for a child will depend on the type of seizures they experience along with the goals for reducing seizures.
How Can Epilepsy Surgery Help?
Because there are different underlying causes for epilepsy, and because each child is unique, pediatric neurologists will create surgical plan based specifically on your child’s physiology and achievable goals for seizure reduction or elimination. Different strategies for treating a child’s seizures with epilepsy surgery generally falls into two categories: definitive and palliative.
When selecting a definitive surgery plan, the goal will be to eliminate seizure’s entirely, or at least to reduce them by 70 to 90 percent. Surgeries that fall under this plan typically involve removing the portion of the child’s brain that is producing the seizures.
The goal with palliative surgery is to reduce the frequency of seizures in the child by disrupting the channels in the brain can increase their intensity. The use of implants to provide electrical pulses to reduce the frequency seizures also falls under the general strategy of palliative surgery.
How Does Epilepsy Surgery Work?
The goal of any epilepsy is to reduce or eliminate the occurrence of seizures by physically altering the brain, whether by removing malfunctioning tissue or blocking neural pathways that enable or worsen seizures.
The type of surgery a child is considered a candidate for will depend on their particular situation. Some of the most common types of surgeries used to treat epilepsy include the corpus callosotomy, hemispherectomy and vagal nerve stimulator.
Vagal Nerve Stimulator
A vagal nerve stimulator is a device similar to a pacemaker that is implanted in the child’s chest. It is connected with electrodes to the vagus and regularly sends out small electrical impulses and can also be activated manually using a magnet in case of a seizure.
The corpus callosotomy is a palliative epilepsy surgery used to reduce seizures by either partially or completely severing the corpus callosum, a group of connective tissues between the brain’s two hemispheres. This stops most of the activity related to a child’s seizures from traveling between the two hemispheres and disrupts synchronous brain discharges.
The hemispherectomy is a type of definitive surgery called resective surgery in which all or a portion of an organ is removed. A hemispherectomy is the removal or disconnecting of one of the hemispheres of the brain, and is used only in rare cases of severe and uncontrollable seizures with weakness or paralysis of one side of the body.
Who Benefits from Having Epilepsy Surgery?
Around one-third of children with epilepsy continue to experience seizures despite treatment with antiepileptic drugs (AED). A child who is a candidate for epilepsy surgery will generally experience complex partial seizures, with or without secondarily generalized seizures, and will have not responded to AED therapy.
To ensure a child is a good candidate for either definitive or palliative epilepsy surgery, pediatric neurologists will carry out tests and examinations such as an electroencephalogram (EEG), magnetic resonance imaging (MRI) or a positron emissive tomography (PET) scan. These tests and others will give the neurologist the best information about the specific nature of a child’s seizures.