More Options Than Ever for Kids With Epilepsy
Advances in Medicines and Surgery Offer New Hope for Seizures
For children with epilepsy, life can be unpredictable and frightening. Until their seizures are controlled, leading a normal life – hanging out at the pool in the summer or getting a good night’s sleep during the school year – eludes them and their families.
Since the 1990s, they’ve had access to medicines that in many cases can control seizures with fewer side effects than those on the market 30 years ago, according to Ki Hyeong Lee, MD, director of epilepsy surgery at Cincinnati Children’s. For patients who don’t respond to medication, surgery can lead to a seven-fold improvement in control, he says, pointing to a recent study out of Canada. At Cincinnati Children’s, even though the surgeries physicians perform here are the most difficult cases from all over the country, Dr. Lee points to a 75 percent success rate in eliminating seizures.
An Electrical Storm
“Epilepsy is an electrical phenomenon that causes small parts of the brain to fire too rapidly,” he says. “Usually the surrounding parts of the brain suppress resulting seizures, but sometimes an ‘electrical storm’ shuts down normal brain functions.”
Seizures can be caused by any number of factors – developmental or chromosomal glitches, hypoxic injury at birth – but most often there is no clear-cut explanation for why they happen. Increasingly doctors are encountering more difficult cases, where nothing shows up on an MRI or CT scan, but the brain malfunctions because of abnormally grown neurons in the brain. In a few cases, epilepsy results from genetic mutations.
Choosing Treatment
Because epilepsy is complicated, it’s important to consult a specialist to determine whether medication or surgery is the better option, advises Dr. Lee.
Although some pediatricians see surgery as a last resort, Dr. Lee believes that many children, especially with severe seizures, can benefit from surgery and begin to lead a normal life sooner. About 70 percent of children respond to medication, while 30 percent will never improve without surgery.
“If children still have seizures after taking adequate doses of two or three drugs for a while, they should seek advice about surgery,” he says.
When children arrive for consultation, Cincinnati Children’s epilepsy specialists use the latest technology, available only in the last five years to a few medical centers in the United States, to identify whether they are candidates for surgery.
After an evaluation, doctors identify the source of the seizure, the size of the seizure source, and how much of the brain can be removed to eliminate seizures without disturbing normal brain function. They perform one or two procedures each week, with three out of four successfully resolving the seizures.
Ongoing Research
Cincinnati Children’s researchers recently examined the long-term effects of epilepsy on the part of the brain that controls language development. Preliminary results indicate that language is poorly developed in children with epilepsy compared to those without the condition.
“Based on this research, we want to get epilepsy under control as soon as possible so the child can develop early language skills, then continue to progress,” says Dr. Lee.
