Children’s Epilepsy Treatments

Epilepsy is the most common brain disorder in children. Children who have epilepsy experience seizures—temporary and sudden changes in movement or behavior.

Seizures occur when the brain fires abnormal electrical signals. As a result, children can become confused, immobile or unresponsive for short periods.

Epilepsy Treatment

The Comprehensive Epilepsy Center at Children’s Hospital offers the most extensive pediatric epilepsy treatment options in the Los Angeles region. We have the largest diet therapy program in the country.

We were among the first program offering many epilepsy surgery options to children. Our expert neurosurgeons, neurologists and epileptologists offer unique treatments like phase 2 testing and brain mapping. These procedures are not available at many other centers—especially those focused on children.

Our experts find the least invasive treatment option that effectively prevents or manages future seizures. Treatment options include:

Medication Therapy

Anti-seizure medications are one of the most common strategies for treating seizures. The right medicine can successfully control seizures in about 70% of patients.

Neurologists can prescribe epilepsy medications that are easy for your child to take, such as:

  • Chewable tablets
  • Liquid formulations
  • Swallowable tablets (for older children)

Epilepsy medication benefits and risks 

All medications have pros and cons. For example, chewable tablets may be easier for children to take, but may have a high sugar content that doesn’t work with a ketogenic diet.

There are many types of epilepsy medication and the same medication will not work for every patient. Your child’s neurologist will discuss the benefits and potential risks of any prescription with you.

Diet Therapy

At least two-thirds of children who start ketogenic diet therapy have a reduction in seizures, and some become seizure-free. Children frequently follow one of these diets:

Ketogenic diet for epilepsy

Ketogenic refers to a way of eating that produces ketones in the body. Ketones are chemicals that the liver makes when the body uses fat as its main source of energy.

Usually, the body uses carbohydrates (such as pasta, bread or sugar) as its primary energy source. When people follow a ketogenic diet, the body uses fats instead.

What will my child eat on a ketogenic diet?

The ketogenic diet is high in fats, such as:

  • Avocado
  • Eggs
  • Oils such as olive or avocado, or others based on preference
  • Heavy cream
  • Butter

Your child’s dietitian creates a meal plan and calculates the amount of calories, fat, protein and carbohydrates necessary to promote a good level of ketosis for seizure control. Caregivers must weigh all foods with a gram scale for accuracy.

A typical meal includes:

  • Small amount of fruit or vegetable
  • Protein-rich food
  • Source of fat such as heavy cream, butter or vegetable oil

Ketogenic diet benefits

Following a ketogenic diet for epilepsy can offer significant benefits. For example:

  • More than half of children who follow this diet have a 50% reduction in seizure symptoms.
  • Some children who follow the diet can decrease or stop seizure medications.
  • Up to 15% of children become seizure-free through diet alone.

Modified Atkins diet for epilepsy

A modified Atkins diet is another version of ketogenic diet therapy. It is a low-carbohydrate, moderate-protein, high-fat eating plan. This diet uses a similar approach of producing more ketones so that the body and brain use fat for energy.

The major difference from a strict ketogenic diet is that individuals following the modified Atkins diet do not need to use a gram scale or follow exact calorie intake guidelines. This provides more flexibility for meals, which is especially helpful with school-age children.

Modified Atkins diet benefits

A modified Atkins diet offers similar seizure-relieving benefits to the ketogenic diet. Additional benefits of the diet include:

  • Increased flexibility in meal choices
  • Increased freedom with no need to weigh foods

Low glycemic index diet for epilepsy

A low glycemic index diet or low glycemic index treatment (LGIT) is a special high-fat diet used for difficult-to-treat seizures. It is less restrictive than the ketogenic diet. On the LGIT, your child eats food according to the glycemic index. Some carbohydrates are allowed, but they are limited to specific selections.

Low glycemic index diet benefits

An LGIT offers similar seizure-relieving benefits to the ketogenic diet. Additional benefits include:

  • Increased flexibility in meal choices
  • Increased freedom with no need to weigh food

Epilepsy Surgery 

Our Neurosurgery Program offers advanced surgical procedures to treat seizures. Children who undergo surgery receive anesthesia to remain numb and asleep throughout the procedure.

Children’s Hospital utilizes ROSA robotic surgical technology for minimally invasive neurosurgical procedures whenever possible. Described as a “GPS for the skull,” the system allows neurosurgeons to be more precise and make smaller incisions during delicate procedures. ROSA facilitates shorter operating times, faster recovery and fewer complications.

Epilepsy surgeries we offer include:

Invasive Monitoring

Invasive monitoring means monitoring with electrodes on the surface of or deep inside the brain. This type of monitoring is much more precise than standard electrodes on the scalp. It helps surgeons make decisions about epilepsy surgery.

What to expect during invasive monitoring:

  1. Surgeons make an incision in the skull and place grids or strips of electrodes on the surface of the brain while the patient is under general anesthesia.
  2. Because the skull is already opened for electrode placement, surgeons may sometimes also perform a resection to reduce seizures.
  3. Patients spend their first night after surgery in the Pediatric Intensive Care Unit to make sure they are recovering well from the procedure.
  4. Patients will then move to the Epilepsy Monitoring Unit (EMU), where they are observed using wall-mounted cameras and state-of-the-art monitoring equipment. Patients may stay in the EMU for up to three weeks while their seizures are monitored.
  5. When physicians have enough information about the child’s seizures, surgeons perform a quick procedure with sedation to remove the electrodes.
  6. After the region of the brain where seizures are originating is identified, brain mapping may be performed.

Stereo EEG

Stereo EEG, also called SEEG, is a specific type of invasive monitoring. This minimally invasive procedure is performed using the ROSA robotic surgery system. It is more sensitive than EEG sensors placed on the scalp. Unlike standard invasive monitoring, surgeons place long, thin electrodes deep inside the brain. It is often performed before surgical procedures to help develop precise surgical plans.

What to expect during a stereo EEG:

  1. Surgeons drill numerous, tiny holes in the skull and place electrodes deep inside the brain.
  2. Patients will then move to the Epilepsy Monitoring Unit (EMU), where they are observed using wall-mounted cameras and state-of-the-art monitoring equipment. Patients may stay in the EMU for up to three weeks while their seizures are monitored.
  3. When physicians have enough information about the child’s seizures, surgeons will perform a quick procedure with sedation to remove the electrodes.
  4. Later during their stay, surgeons may use laser ablation to correct seizures.

Brain Mapping

Brain mapping, also called epilepsy focus mapping, uses electrodes to map the specific source of seizures in the brain, as well as areas of the brain that control speech and movement. After the brain is mapped, surgeons use this information to remove seizure-causing tissue and avoid functional areas of the brain, to make sure that speech and movement aren’t affected after surgery.

What to expect during brain mapping:

  1. Surgeons make an incision and remove a piece of the skull, which will be replaced at the end of the surgery.
  2. A grid of electrodes, called a subdural grid, will be placed on the surface of the brain.
  3. Patients will spend their first night after surgery in the Pediatric Intensive Care Unit to make sure they are recovering well from the procedure.
  4. Patients will then move to the Epilepsy Monitoring Unit (EMU), where they are observed using wall-mounted cameras and state-of-the-art monitoring equipment.
  5. After moving to the EMU, an epileptologist uses the subdural grid to send electrical currents to stimulate portions of the brain, while monitoring the child’s language and movement. Through this process, we learn which areas the surgeon should remove to reduce seizures, and which area should be avoided to preserve speech and movement.
  6. When physicians have enough information about the child’s seizures, surgery will be planned to remove seizure-causing areas of the brain, and the subdural grid will be removed as well.

Resective Surgery 

Resective surgery, or resection, is the most common type of epilepsy surgery. Neurosurgeons remove the portion of the brain that is causing seizures.

What to expect during resective surgery:

During surgery, the neurosurgeon:

  1. Takes off a small part of the skull to access the brain
  2. Removes the parts of the brain causing seizures
  3. Replaces the bone in the skull and closes the area with stitches or staples

After surgery, your child stays in the hospital to recover for about three days.

Laser ablation surgery

Laser ablation surgery may be the right treatment for your child’s seizures. Surgeons map the precise seizure location of seizure onset and destroy cells with light and heat. The goal of this treatment is to treat the cells causing the seizure without affecting any healthy parts of the brain.

Neurosurgeons at Children’s Hospital also use an advanced MRI-guided laser ablation technology called Visualase. The ROSA robotic system and Visualase allow surgeons to operate through one small incision. This minimally invasive approach means your child benefits from:

  • Faster recovery
  • Less pain
  • Reduced risk of complications

What to expect during laser ablation surgery 

During surgery, the neurosurgeon:

  1. Uses the ROSA robot to pinpoint the exact treatment location
  2. Makes a small incision in the skull, then uses Visualase to place a tiny, flexible tube called a laser probe into the tumor
  3. Takes a magnetic resonance imaging (MRI) scan, which shows an image of the inside of the brain, to make sure the probe is in the correct location
  4. Turns on the laser in the probe to send light and heat to the tumor
  5. Removes the probe and closes the skull and scalp with stitches

Vagus nerve stimulation

The vagus nerve sends messages from the brain to other parts of the body that control movement or sensory functions. Vagus nerve stimulation uses a small device (similar to a pacemaker) to send mild pulses to the vagus nerve throughout the day to help prevent seizures.

If your child has seizures that are not effectively controlled by medication, vagus nerve stimulation may help. Stimulating the vagus nerve can help reduce the number and severity of seizures your child has.

What to expect during vagus nerve stimulation

During the procedure, the neurosurgeon:

  1. Makes small incisions in the upper left side of the chest and the lower left side of the neck
  2. Places the stimulator in the upper chest
  3. Connects small wires (leads) from the device to the vagus nerve in the lower neck (these wires run underneath the skin, so you cannot see them)
  4. Closes both incision sites with stitches

After surgery:

  1. Your child follows up with an epilepsy specialist who programs the stimulator device.
  2. The device sends out intermittent electrical pulses that help control seizures. Your child usually does not feel these impulses and they are not painful.

Responsive neurostimulation

Responsive neurostimulation is another technique for controlling electrical signals in the brain to reduce seizure activity. With responsive neurostimulation, surgeons connect the neurostimulator device directly to the brain. The device detects the beginning of a seizure and sends pulses to the brain, ending the seizure right when it starts.

Responsive neurostimulation works well for seizures that come from multiple areas of the brain or seizures that are in areas of the brain that are not safe to operate on.

What to expect during responsive neurostimulation

During the procedure, the neurosurgeon:

  1. Makes small incisions in the skull
  2. Places the stimulator in the brain
  3. Closes incision site with stitches

After surgery:

  1. Your child follows up with an epilepsy specialist who programs the stimulator device.
  2. The device sends out electrical impulses only when there is abnormal brain activity. These impulses stop a seizure at the very beginning, often before the person knows it has started. 

Hemispherectomy

The brain has two halves, or hemispheres. A hemispherectomy is a rare procedure where surgeons remove part of one of these hemispheres.

Sometimes, children have overgrowth in one side of the brain that leads to seizures. If your child has not experienced improvement after taking seizure medications, a hemispherectomy might be a good treatment. For the majority of children, a hemispherectomy reduces the frequency and severity of seizures. This procedure can also help children with Sturge-Weber syndrome, or who have suffered from neonatal stroke.

What to expect during a hemispherectomy

During surgery, the neurosurgeon:

  1. Takes off a small part of the skull to access the brain
  2. Removes the parts of the brain causing seizures
  3. Replaces the bone in the skull and closes the area with stitches or staples

After surgery, your child:

  1. Stays in the hospital to recover for about seven days
  2. May undergo physical therapy or occupational therapy, to help with speaking, moving and returning to usual activities

Corpus callosotomy

The corpus callosum is a bundle of nerves that sends messages from one side of the brain to the other. A corpus callosotomy (also called split brain surgery) involves cutting the corpus callosum to break this connection. Breaking this connection can stop the spread of seizure activity from one side of the brain to the other.

This surgery can be an effective treatment if your child has seizures with no known cause that cannot be controlled with medication. A corpus callosotomy does not stop seizures entirely, but it can reduce the severity of seizure symptoms. Up to 75% of children experience a decrease in drop attacks, or seizures where they immediately fall to the ground. A decrease in drop attacks can significantly decrease your child’s chances of injury.

What to expect during a corpus callosotomy

During surgery, the neurosurgeon:

  1. Removes a small piece of the skull to access your child’s brain
  2. Uses small tools to access the space between the two halves of the brain
  3. Cuts the back portion of the corpus callosum (partial callosotomy) or all of the corpus callosum (full callosotomy)
  4. Closes the area with stitches or staples

After surgery, your child:

  1. Recovers in the hospital, usually for about a week or more
  2. Can typically return to usual activities within six to eight weeks

Epilepsy Care at Children’s Hospital Los Angeles

Patients in our program benefit from expert treatment that promotes excellent outcomes. Learn more about our Comprehensive Epilepsy Center.

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