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. The type of medication your child will receive depends on many factors. Your child's neurologist will explain how the medication should be taken 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.

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

Ketogenic Diet

This special high-fat, low-protein, no-carbohydrate diet has been recommended for many years for some children with epilepsy who do not respond to medications. The diet mimics certain effects of starvation, which helps to prevent seizures. Our dietitian will work closely with you and your child to help incorporate the diet into your family's lifestyle. Strict adherence to the diet is essential for the treatment to be successful.

We collaborate with experts at Lucile Packard Children's Hospital, Children's Hospital Oakland and UC Davis Medical Center in providing the Ketogenic diet.

Surgery

Surgical procedures may be considered to prevent seizures or to implant devices that deliver medications or stimulators to emit electrical impulses. These procedures include:

• 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.
• 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 the removal of 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, during which a portion of the temporal lobe is removed to control seizures.
• Lobar resection, during 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, during 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.
• 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, can be treated with this technology. Doctors at UCSF are involved in research using the Gamma Knife to treat temporal lobe epilepsy.
• Vagus nerve stimulation involves minor surgery and is a relatively new treatment that helps prevent or lessen the severity of seizures. An electrical stimulator is implanted that sends regular electrical pulses through the vagus nerve to the brain to reduce the onset or frequency of seizes.

  If a seizure occurs between doses of current, you or your child can pass a magnet over the device to trigger an additional dose. A child with a vagus nerve stimulator continues to take medication but sometimes can reduce the amount or number of medications. This procedure can treat a wide variety of seizure disorders when surgery isn't an option.

Prevention and Follow-Up

To help cope with epilepsy and reduce your childs 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 Children's Hospital.
Last updated November 6, 2009