More than half of children with epilepsy can obtain control of their seizures with one medication. Treatment goals emphasize using the minimum amount of medication necessary to achieve seizure control, and monitoring children on an ongoing basis to minimize side effects. Our neurologists have extensive experience in administering the full spectrum of available medical therapies, ranging from traditional medical protocols to novel pharmacotherapies.

The ketogenic diet is a specialized, medically-supervised diet that may be appropriate for children with certain types of epilepsy and children who do not respond well to standard medication therapies. The diet is high in fat, and low in carbohydrates and protein. Our ketogenic diet team includes neurologists, dietitians, social workers, pharmacists, nurses, and our program coordinator. We also have a nurse practitioner with special expertise working with families adjusting to the ketogenic diet. Our multidisciplinary team meets monthly to review our protocols, plan for our newest patients’ care, and problem-solve any issues arising for our established patients.

In many cases, surgery can either eliminate seizures or significantly improve quality of life for children with continued, disabling seizures that do not respond to other therapies. Our renowned pediatric neurosurgical team has deep expertise with surgical techniques to help control seizures. Our presurgical evaluation is designed to pinpoint where in the brain seizures are starting and assess how removing that tissue might affect the child’s functioning. 

Surgery can be used to temporarily implant electrodes on or in the brain to precisely define the part of the brain causing seizures and to confirm what neurological functions that part of the brain performs. If it is determined that the part of the brain causing seizures is not responsible for critical neurological functions, surgical removal of this area is an option and can be highly successful in controlling a child’s seizures. C.S. Mott Children’s Hospital offers an intraoperative MRI operating room for epilepsy surgery patients, which allows for a higher level of precision for surgeons performing these delicate procedures.

When the part of the brain causing seizures cannot be precisely identified or cannot be safely removed, a child may be a candidate for an implantable neurostimulator. These devices all deliver mild electrical stimulation to the brain to stop or reduce epileptic seizures. There are currently three neurostimulation therapies available:

• Vagus Nerve Stimulation (VNS) – A pulse generator is implanted under the skin in the chest. This connects to a lead that wraps around the vagus nerve in the neck. The VNS sends periodic stimulation to the brain throughout the day via the vagus nerve. Additionally, a magnet can be used to deliver on-demand stimulation, and the device can be set to provide stimulation in response to a sudden increase in heart rate (a possible sign of a seizure).
• Deep Brain Stimulation (DBS) – Two leads are inserted into a deep brain structure called the thalamus, which is thought to play a role in many types of epilepsy. These leads are connected to a neurostimulator, implanted under the skin in the chest, that periodically stimulates the thalamus. The device can also deliver on-demand stimulation and record electrical activity in this region of the brain.
• Responsive Neurostimulation (RNS) – The RNS neurostimulator device is embedded in the skull, and electrode strips or depth electrodes are implanted near one or two seizure foci and/or in the thalamus. The device constantly records the electrical activity in the targeted areas and delivers stimulation directly to them when the early signs of a seizure are detected. The timing of this stimulation can be adjusted based on analysis of the recordings.

Two main types of surgery can use a laser or cutting tool to sever connections that allow for the rapid spread of seizure activity. Corpus callosotomy severs a bundle of nerve fibers connecting the two halves of the brain. This surgery is most effective in reducing or eliminating atonic seizures, but it may help reduce other generalized seizures as well.

Hemispherectomy may be considered when all seizures are coming from one side of the brain, and that side is also functioning poorly. The surgery disconnects this hemisphere from the other hemisphere and the rest of the body, often eliminating seizures entirely. This surgery can have a significant impact on vision, strength, and movement, so extensive post-surgical rehabilitation is often needed.