Epilepsy
Treatment

Your child's team of doctors and health professionals will design a treatment plan for your child's specific needs, a plan that may include more than one kind of treatment. Your child also may be referred to additional doctors or other medical professionals.

Most medical treatments involve some risks or complications. We will explain possible risks or complications related to your child's treatments. Feel free to ask questions about your child's treatment.

Medications

In many cases, seizures can be successfully prevented with medications. There are more than 20 medications used to treat seizures in children. Many of these are not formally approved for children but are very commonly used in the pediatric population.

The type of medication your child will receive depends on many factors and every child is different. Your child's neurologist will explain how to take the medication and the side effects that may occur. Over time, your child's medication regimen may be changed. It is very important that your child take the medication exactly as directed. Call your neurologist if you have any questions about the medications or if your child is experiencing unexpected side effects.

If the first medication chosen is not effective, your doctor will discuss the next medication option. The goal is for your child to have no seizures and no side effects, and the treatment plan may change at any time depending on how your child responds. Some children require two to three medications to control their seizures; monitoring for side effects while on these combinations is very important.

Some patients do not respond to medications and continue having seizures. In these cases, other testing and treatments may be recommended.

Surgery

Surgery is often considered if medications fail to control seizures. There are many different types of surgical procedures used to prevent seizures.

If surgery is an option, your child will undergo additional tests to pinpoint the location of the seizures. These tests include inpatient video EEG monitoring, high-resolution MRI, magenetoencephalography (MEG), brain PET scans or SPECT scanning. Once the presurgical evaluation is complete, your doctor will discuss what type of surgical procedure is the best option for your child.

Procedures used to control seizures include:

  • Focal resections are the most common surgical approach for treating epilepsy and provide the best chance for patients to gain complete seizure control. These procedures involve removing a small area of the brain where seizures originate. New brain monitoring techniques allow doctors to better pinpoint brain tissue causing seizures. Types of resections include:
    • Temporal lobectomy, in which a portion of the temporal lobe is removed to control seizures.
    • Lobar resection, in which a portion of a seizure-producing lobe — frontal, parietal or occipital lobe — is removed, if it can be done without damaging vital functions.
    • Hemispherectomy, in which one sphere of the brain is removed or disabled. The remaining half of the brain takes over many of the functions of the half that was removed. This procedure is used to treat severe conditions that have not responded to other treatments.
  • Disconnection procedures, which disrupt abnormal electrical activity that occurs in the brain and triggers epileptic seizures. Two types of disconnection operations are:
    • Corpus callostomy, which stop atonic and tonic seizures.
    • Multiple subpial transections, which are performed when seizures are caused by parts of the brain that can't be removed.
  • Gamma Knife radiosurgery delivers a finely focused, high dose of radiation to remove tissue without damaging surrounding tissue. Some types of seizures such as gelastic seizures, which are accompanied by brief, sudden bursts of emotion, may be treated with this technology because they come from an area of the brain that is difficult to access in other ways.
  • Vagus nerve stimulation involves minor surgery to implant an electrical stimulator under the skin on the right side of the chest. The stimulator sends regular electrical pulses through the vagus nerve to the brain to reduce the onset or frequency of seizures. If a seizure occurs between doses of current, you or your child can pass a magnet over the device to trigger an additional dose.

    Vagus nerve stimulation helps prevent or lessen the severity of seizures in children when open brain surgery is not an option. Children with a vagus nerve stimulator continue to take medication, but can sometimes reduce the amount or number of medications.

Ketogenic Diet

This special high-fat, low-protein, no-carbohydrate diet has been recommended for many years for some children with epilepsy that do not respond to medications. The diet mimics certain effects of starvation, which helps to prevent seizures.

Our pediatric dietitian has specialized training in starting and managing the ketogenic diet. This treatment involves an initial clinic visit, followed by a three- to four-day hospital stay when a team of doctors will follow your child closely and train the caregivers on how to make each meal.

This can be a very effective treatment, with approximately 25 percent of children becoming seizure-free and another 50 percent having more than a 50 percent reduction in seizures. While these are excellent outcomes, the diet is often difficult on the child and the rest of the family. With the appropriate guidance, however, it can often be successful.

Prevention and Follow-Up

To help cope with epilepsy and reduce your child’s chance of injury from seizures, we recommend these guidelines:

  • Have your child carry identification, such as a bracelet, card or necklace that indicates that your child has epilepsy. In an emergency, this information can ensure that your child receives the right care.
  • Explain to family, friends, teachers and sports coaches how to care for your child if he or she has a seizure.
  • If your child has regular or even occasional seizures, make sure your child avoids dangerous situations at school and during leisure activities. Your child should be careful when playing sports and should not swim unattended.
  • Your child should never stop taking seizure medication or change the amount taken without discussing it with a doctor first.
  • Talk to your child's doctor or pharmacist before taking other medications in addition to seizure drugs.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Pediatric Brain Center

Pediatric Epilepsy Center of Excellence
1825 Fourth St., Fifth Floor
San Francisco, CA 94158
Phone: (415) 353-2437
Fax: (415) 353-2400
Appointment information

Neurosurgery Clinic
1825 Fourth St., Fifth Floor, 5A
San Francisco, CA 94158
Phone: (415) 353-7500
Fax: (415) 353-2889
Appointment information

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