Epilepsy

Treatment of Children

Mayo pediatric EEG volumes — Minnesota

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

In Mayo's efficient system, children often complete the entire evaluation and treatment process in less than three weeks. Mayo physicians are committed to making young patients feel comfortable. They also strive to maintain ongoing communication with parents.

Mayo Clinic pediatric neurologists and neurosurgeons may offer children and their families options that are available at only a few medical centers, including 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 with epilepsy who visit Mayo Clinic in Minnesota are treated at Mayo Eugenio Litta Children's Hospital, a family-friendly, state-of-the-art children's hospital within Saint Marys Hospital. Children have access to entertainment, including toys, movies and games, while hospitalized at Mayo Eugenio Litta Children's Hospital.

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.

Some seizure disorders continue and may worsen over time. About one-third of girls with epilepsy, for example, have more seizures when they begin menstruation. Learn more about epilepsy treatment considerations specific to women.

Mayo Clinic in Rochester, Minnesota, is ranked No. 1 in Neurology & Neurosurgery in the U.S. News & World Report Best Hospitals rankings.

Seizure hot spots in the brain

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Diagnosis

Mayo Clinic pediatric neurologists use appropriate electroencephalogram (EEG) and magnetic resonance imaging (MRI) studies to carefully evaluate and help define the seizure types and epilepsy syndrome. MRI and SISCOM (an imaging technology developed by Mayo Clinic that pinpoints seizure locations) accurately locate 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 with epilepsy 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. Learn more about epilepsy diagnosis.

Treatment Options

All diagnosis and treatment options for epilepsy described in these pages are available for children at Mayo Clinic in Minnesota.

At Mayo, medication is the first line of treatment for children with epilepsy. Medication is recommended when there is a significant likelihood that additional seizures will occur and cause potential physical, educational or social harm. The best predictor of future seizures is proper identification of seizure types and epilepsy syndrome.

If seizures persist despite the use of anti-epileptic medications, several alternatives are available. Mayo physicians recommend alternative treatments such as the ketogenic diet, surgery or vagus nerve stimulation, depending on seizure types and underlying cause.

Ketogenic Diet

The ketogenic diet prompts the body to produce ketones, causing the body to use fat instead of glucose for energy. Mayo Clinic has used the ketogenic diet, primarily for children with epilepsy, since 1921. Mayo Clinic in Minnesota is the only Mayo location that offers this treatment.

Exactly how the ketogenic diet works is not known, but the high-fat, low-protein, no-carbohydrate diet mimics some effects of starvation that seem to inhibit seizures. The diet is 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 patients with epilepsy. Close collaboration with an experienced dietitian familiar with the ketogenic diet and dedicated participation by the patient and family are essential for this treatment to work.

Surgery

Surgery may be an option for children with epilepsy 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. Mayo surgeons use computer-assisted brain surgery to operate in the brain with great precision.

Mayo neurosurgeons perform surgery called hemisphereotomy to treat seizures affecting most or all of one side of the brain. In hemisphereotomy, surgeons disconnect ventricles connecting the diseased and healthy parts of the brain. Traditional surgical procedures to remove most or all of one side of the brain may cause severe complications. Hemisphereotomy offers the possibility of fewer complications.

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

Vagus Nerve Stimulation

The vagus nerve reaches from the brainstem to the colon and supplies nerve fibers to the pharynx (throat), esophagus, heart, lungs and other body organs. It also returns sensory information to the brain from the tongue, ears, pharynx and larynx (voice box).

Vagus nerve stimulation is approved by the U.S. Food and Drug Administration (FDA) to treat partial seizures in patients age 12 and older. The stimulation device reduces seizure frequency and intensity in some patients. Approximately 30 to 50 percent of patients experience reduced 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 does not detect seizure activity. It 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 stimulator can be adjusted easily in a physician's office using a laptop computer.

Treatment Team

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

Appointments

For appointments or more information, call 507-284-1588 8 a.m. to 5 p.m. Central time Monday through Friday.