Children and Solutions for Serious Epilepsy

More children may be eligible for surgery than previously thought

Baby holding finger

When medication fails and seizures are uncontrollable, children with epilepsy  have few options. Sometimes brain surgery can help, but doctors approach surgery cautiously. Here’s how they decide if surgery is an option.

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Doctors usually use 2 tests together to decide which patients are eligible:

  1. Electroencephalograph (EEG), or brain-wave reading. This normally looks like a wavy line. For some patients, the wavy line will spike in certain places. If so, the seizures come from a focal “trigger zone” in the brain.
  2. Magnetic resonance imaging (MRI). MRI can reveal a brain lesion related to the seizures.

When MRI shows a lesion and EEG indicates a trigger zone, doctors usually feel they can commit to surgery.

Research shows more children may benefit

When it comes to deciding about treatments, and surgery in particular for children, “we want to make sure we do no harm,” says Elaine Wyllie, MD, a pediatric epilepsy specialist at Cleveland Clinic Children’s Hospital. “But some people suffer for a long time before getting surgery.”

In the past, only some infants were considered eligible for surgery without strong evidence of a trigger zone. But Dr. Wyllie’s research has shown surgical treatment may be an option even without that evidence. A certain type of “focal” lesion seen on MRI — one that doctors recognize as having formed in early brain development  — may be the key to successful surgery.

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Findings: 72 percent of children ‘seizure-free’

Dr. Wyllie and her colleagues have studied children and adolescents with profound epilepsy and focal lesions but no clear trigger zone. When these children had surgeries as a last resort, there were no mortalities. Seventy-two percent of the patients became seizure-free. Follow-up studies at Cleveland Clinic have confirmed this.

“The key is not the patients’ age when they’re evaluated for surgery but whether the lesion found on MRI occurred in infancy or before,” Dr. Wyllie says.

She is excited about what this may mean for children and teens with uncontrolled seizures. But she stresses that more research is needed to establish a firm connection between the type of lesion and whether epilepsy surgery will be successful.

“There’s a certain population of children we thought was ineligible for surgery,” she says. “It turns out that we may have a solution for them.”

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