Epilepsy

Treatment of Children

The goal of Mayo Clinic's multispecialty pediatric neurology team is to find the most appropriate treatment for a child with epilepsy. Careful diagnosis and management can help children with epilepsy lead fulfilling and productive lives.

Mayo Clinic Pediatric EEG Volumes - Minnesota

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In Mayo's efficient system, children can often go through the entire evaluation and treatment process in one to three weeks. Some patients may require a longer period of monitoring and treatment. Throughout treatment, physicians are committed to making patients feel comfortable and strive to maintain ongoing communication with parents.

Sometimes, Mayo Clinic pediatric neurologists and neurosurgeons can offer children and their families options that are available at only a few medical centers. These options include the ketogenic diet for medical management of epilepsy and surgical treatments such as hemisphereotomies for seizures that originate from a particular section of the brain.

Children who come to Mayo Clinic's site in Minnesota are treated at Mayo Eugenio Litta Children's Hospital, a state-of-the-art, family-friendly children's hospital within Saint Marys Hospital. While hospitalized, children have access to entertainment, including toys, movies and games.

Some children with specific epilepsy syndromes may stop having seizures as they approach adulthood. Other syndromes are associated with continued, but infrequent, seizures or are easily controlled with medication. Unfortunately, some seizure disorders continue and may worsen over time. About one-third of girls with epilepsy, for example, have more seizures when they begin menstruating. Learn more about treatment considerations specific to women.

Diagnosis

High-tech imaging pinpoints seizure hot spots in the brain.

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Careful evaluation by a Mayo pediatric neurologist with appropriate electroencephalogram (EEG) and MRI studies can help define the seizure type(s) and epilepsy syndrome. MRI and SISCOM technology accurately locates the seizure hot spots in the brain. Children also are monitored in the video-EEG monitoring unit at Mayo Eugenio Litta Children's Hospital. Children may be monitored for 24 hours to several days, depending on the time necessary for neurologists to record at least three seizures and effectively pinpoint seizure hot spots. See epilepsy diagnosis.

Treatment Options

In general, epilepsy treatment options for children are the same as for adults.

Medications are the first line of treatment. Medication should be started when there is a significant likelihood that additional seizures will occur and will cause potential physical, educational or social harm. The best predictor is proper identification of seizure type(s) and epilepsy syndrome.

If seizures persist despite trials of anti-epileptic medications, several alternatives are available, depending on seizure
type(s) and underlying cause:

• Surgery
• Vagus nerve stimulation
• Ketogenic diet

Surgery

Surgery may be an option for children who do not respond well to medications. Diagnostic tests will help determine if the child is a good candidate for surgery. During epilepsy surgery, Mayo pediatric neurosurgeons resect (remove) the small section of the brain causing the seizures, without injuring surrounding healthy brain tissue. Computer-assisted brain surgery allows Mayo surgeons to operate in the brain with great precision.

Mayo neurosurgeons also perform surgery called hemisphereotomy to treat seizures affecting most or all of one side of the brain. In this procedure, surgeons disconnect ventricles connecting the diseased and healthy parts of the brain. A hemisphereotomy is a better alternative than traditional surgical procedures to remove most or all of one side of the brain, which can cause more severe complications.

Minimally-invasive endoscopic surgery may be performed in children with a rare type of seizure disorder called gelastic or laughing seizures. A small opening is made in the skull, and a long, thin tube containing a small camera (endoscope) is threaded into the hypothalamus area of the brain. The surgeon then locates and removes the tissue causing the problem. Alternatively, the tissue may be treated with stereotactic radiosurgery.

Vagus Nerve Stimulation

Vagus nerve stimulation is approved to treat partial seizures in patients 12 and older. The stimulation device can reduce seizure frequency and intensity in some patients. Approximately 30 to 50 percent of patients have less seizure activity with vagus nerve stimulation.

The vagus nerve stimulator is surgically implanted under the skin in the chest. The device is connected to a wire that is tunneled under the skin and attached to the vagus nerve in the left side of the neck. The surgery requires only a one-night stay for most patients.

The vagus nerve stimulator is adjusted to automatically stimulate the vagus nerve in increments that depend on the patient's condition and can range from every few seconds to every few minutes. The patient or caretaker can also turn on the stimulator with a magnet. The device does not detect seizure activity. It can be adjusted easily in a physician's office using a laptop computer.

Ketogenic Diet

The goal of the ketogenic diet is to prompt the body to produce ketones, which cause the body to use fat, instead of glucose, for energy. The diet has been used at Mayo Clinic since 1921, primarily in childhood epilepsy. Mayo Clinic in Minnesota is the only Mayo location offering this treatment. Exactly how the ketogenic diet works is not known. The high-fat, low-protein, no-carbohydrate diet mimics some effects of starvation that seem to inhibit seizures. The diet is very rigid and carefully controlled, and must be supervised by a physician — sometimes in the hospital.

Ketogenic diets have been used for children who have epilepsy for many years. The success rate is approximately 50 percent. Recently, less strict versions of the ketogenic diet (a modified Atkins diet or a low glycemic index diet) have worked well for some persons with epilepsy. Close collaboration with an experienced dietitian familiar with the ketogenic diet, and the patient's and family's dedicated participation are essential for this treatment to work.

Treatment Team

Members of the Division of Child and Adolescent Neurology evaluate and treat patients with epilepsy.

Appointments

For appointments or more information, call 507-284-9974 between 8 a.m. and 5 p.m. Central time Monday through Friday.