If you have a child with epilepsy who has tried two or more anti-seizure medications but is still experiencing seizures, these treatments may help.
Nearly half a million U.S. children have epilepsy, according to the Centers for Disease Control and Prevention. While most can control the condition with anti-seizure drugs, about 1 in 5 cases of pediatric epilepsy are drug-resistant. For these children and their families, finding a way to reduce the frequency and severity of seizures is critical.
“The sooner a child’s epilepsy can be treated, the better,” said Dr. Renée Shellhaas, M.D., M.S., a member of the American Epilepsy Society (AES) board of directors and the associate dean for faculty promotions and career development at the Washington University School of Medicine in St. Louis. “Stopping seizures can help children’s development and behavior, and reduce their risk of SUDEP [Sudden Unexpected Death in Epilepsy Patients].”
Fortunately, there are many new and existing pediatric epilepsy treatments that either don’t involve medication or can be used in conjunction with it. Here are a few of the most promising non-medication therapies:
Surgery
Renée Shellhaas, M.D., M.S.
Board Member, American Epilepsy Society; Associate Dean of Faculty Promotions and Career Development, Washington University School of Medicine in St. Louis
Surgery is viewed as the frontline treatment for patients with epilepsy who are still experiencing seizures after trying two anti-seizure medications. The goal of epilepsy surgery is generally to remove the part of a person’s brain that is causing them to have seizures.
“If there is a scar or an area of the brain that formed abnormally, but the rest of the child’s brain is healthy, then removing the abnormal area can stop the seizures,” said Dr. Shellhaas, a pediatric neurology clinician-investigator, adding that the removal of this tissue is called a resection.
Childhood epilepsy surgery may seem like an extreme treatment plan for some families, however, Dr. Shellhaas says that if a pediatric epilepsy team recommends the procedure, it is often worth it.
“It’s scary to think about bringing in your child for epilepsy surgery,” she said. “But surgery can offer hope for many families — and I have cared for families who wished they had been offered epilepsy surgery sooner. Early referral to a Level IV epilepsy center can make all the difference.”
Neuromodulation
Chengyuan Wu, M.D., M.S.Bm.E.
Chief, Division of Epilepsy and Neuromodulation Neurosurgery, Thomas Jefferson University
Surgery is an effective epilepsy treatment because it can disrupt the abnormal network of neurological connections that causes chronic seizures. However, there are side effects to removing part of the brain.
“That’s why the balance is always aimed at removing as much of the epileptogenic brain as possible, while minimizing any collateral damage to surrounding structures,” said Dr. Chengyuan Wu, M.D., M.S.Bm.E., chief of the Division of Epilepsy and Neuromodulation Neurosurgery at Thomas Jefferson University Hospital in Philadelphia.
In situations where the “seizure onset zone” in the brain either cannot be clearly identified or overlaps with a part of the brain that cannot be removed, neuromodulation can be an effective alternative to surgery.
“By stimulating parts of the seizure network, neuromodulation can help to disrupt seizures,” Dr. Wu said. “At the same time, because neuromodulation does not involve removal of any part of the brain, its effects are reversible.”
Dr. Wu says deep brain stimulation (DBS) is an exciting therapy because it can stimulate areas of the thalamus when the exact location of the seizure onset zone(s) cannot be identified. Responsive neurostimulation (RNS), on the other hand, is more sophisticated and works like a sort of “defibrillator for the brain,” only stimulating when it detects seizure activity. Vagus nerve stimulation (VNS), which stimulates the vagus nerve in the neck, has also been effective for reducing the number and severity of seizures in some cases.
“As we learn more about how to clearly identify these seizure networks,” Dr. Wu said, “I think we will be able to leverage these technologies to better help patients.”
Medical diets
Mackenzie C. Cervenka, M.D.
Medical Director, Adult Epilepsy Center, Johns Hopkins Hospital
If medication and surgery are ineffective, one of three variations of the ketogenic diet (a classic ketogenic diet, a modified Atkins diet, or a low glycemic index diet) could help reduce seizures for children and adults with epilepsy.
High in fats and low in carbs, ketogenic diets encourage the body to use fat instead of sugar for energy. The results speak for themselves: About half of children and over one-third of adults with epilepsy who start a ketogenic diet have fewer seizures.
“Ketogenic diet therapies are considered standard of care for patients with glucose transporter type I deficiency syndrome,” said Dr. Mackenzie C. Cervenka, M.D., medical director of the Adult Epilepsy Diet Center at Johns Hopkins Hospital in Baltimore.
Dr. Cervenka noted that those with Dravet syndrome, epilepsy with myoclonic-atonic seizures, and tuberous sclerosis complex among other epilepsy syndromes have also responded well to ketogenic diet therapies.
