These surgeries are considered for patients who have epilepsy involving multiple regions of brain, or areas of the brain that likely cannot be removed without causing impairment.
Corpus callosotomy involves cutting the corpus callosum, a band of nerve fibers that connects the two halves of the brain. This interrupts the spread of seizures from one side of the brain to the other.
Corpus callosotomy may be recommended for children who experience generalized seizures, especially the type that involve “drop attacks,” when the child suddenly slumps, falls forward or drops to the ground.
After this procedure, about 75 percent of patients no longer experience “drop attacks,” although they may continue to have other types of seizures.
Vagus Nerve Stimulation
The vagus nerve is one of the largest nerve systems in the body. It helps control several systems, including the heart and digestive tract.
A vagus nerve stimulator is used to reduce the frequency of seizures, and can also help stop a seizure. The surgeon implants this small device below the child’s left clavicle (collarbone), and attaches it to the vagus nerve with a small electrode wire. The device stimulates the vagus nerve, cycling on and off around the clock. If a parent or caregiver notices that a seizure is beginning, he or she can “swipe” a special magnet over the vagus nerve stimulator to send a stronger, immediate stimulation of the nerve. This can stop the seizure from progressing.
Vagus nerve stimulators are sometimes recommended for children with partial and generalized seizures who are not experiencing adequate seizure control with medication alone. The device can help significantly reduce seizures in approximately 50 percent to 75 percent of patients.
Responsive Neuro Stimulation (RNS)
Responsive Neuro Stimulation (RNS), or NeuroPace RNS® System, has two main parts: a generator and wires placed into the brain region(s) causing seizures. The RNS generator collects data sent from the brain. You upload this data to the cloud every day. The RNS can be programmed in the office so that it sends a signal to the brain when the earliest sign of a seizure is detected. This signal is a therapy. It is designed to stop the seizure at this earliest sign, even before your child has symptoms of a seizure. RNS decreases seizure frequency and severity in most patients who have the device.
Placement of a RNS device is an option for children with seizures occurring in 1 or 2 small areas of the brain. If removing these brain regions will cause serious side effects, RNS can be a way to target these brain regions without removing the tissue.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) is a treatment that involves placement of depth electrodes into a "deep" area of brain, typically in or near an egg-like structure called the thalamus. A generator is also implanted away from the head. This generator is connected to the depth electrodes and is programmed to send regular signals to the brain. DBS can be used in many different neurological disorders. DBS can be performed for children with epilepsy who have either had brain surgery and continue to have seizures, or children who are not candidates for resective brain surgery. When performing DBS for epilepsy, usually one electrode is placed in each brain half (hemisphere).