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Treatment

There are several special diets which may be useful in controlling seizures. Each of the diets are low in carbohydrate and most have a higher fat content. The classic, ketogenic diet, consists of large amounts of fat with minimal carbohydrates and just enough protein for growth. There are also modified diets which may be more palatable than the classic ketogenic diet such as the Low-Glycemic diet and the Atkins diet. These modified diets allow for higher amounts of carbohydrate and protein.

Each of these dietary therapies should never be tried without the direction of a child neurologist and nutritionist.

For more information, see the Epilepsy Nutrition Program at Boston Medical Center,http://lowcarblowglycemicseizurediet.com/ and the links to the right of this screen.

Medication

Most children with epilepsy take one or more medications for seizure control. Medicines for seizures are called anticonvulsants.

It is important to know your child’s medicines and doses. We recommend that you keep a small notebook or card with the names of each medicine and dosage. In addition, it is very helpful to keep a list of medications tried in the past and a brief reason why the medication was discontinued. You should alert the physician if your child has an allergy to medication.

Side effects

The goal of seizure therapy is to eliminate seizures without causing side effects, but sometimes this is not possible. You must weigh the benefits of treatment against side effects. With the help of your child’s neurologist, try to determine if the seizures or medication pose more risk to your child and how seizures and medication impact quality of life. If the seizures are brief and do not interfere significantly with daily activities, it is not unreasonable to lower the dosage of medications.

Vagal Nerve Stimulation

The vagal nerve stimulator is a pacemaker-like device that may diminish seizures by sending electrical impulses to the brain. It is typically used when a child has not responded well to several medicines.

The vagal nerve stimulator has a few important advantages to consider: It does not cause sedation or interact with medications. Also, the stimulator can be activated at the first signs of seizure which may shorten the duration of the seizure.

The vagal nerve stimulator requires surgery to implant the device. Typically, this is a day surgery procedure. The generator portion is a small round disc that is inserted under the skin of the chest. A wire, the lead, is coiled around a nerve in the left side of neck, the vagus nerve. The vagus nerve connects to the brainstem, or stalk of the brain.

The generator is programmed to go on and off for a certain number of seconds or minutes. In addition, the vagal nerve stimulator may be activated during a seizure by swiping a magnet over the area of the chest where the stimulator was implanted.

The vagal nerve stimulator is usually used in combination with seizure medication or the ketogenic diet. It is rare to only use the vagal nerve stimulator for seizure control. The vagal nerve stimulator may not alter seizures for several months after surgery; the best results are noted three months to one year after the device is implanted.

Not everyone is a candidate for the vagal nerve stimulator. Risks and benefits should be reviewed carefully with your child’s neurologist before proceeding.

Surgery

Most patients with epilepsy do not require epilepsy surgery. Over the last few years, however, it has become an important treatment option for patients who continue to have poorly controlled seizures despite trying several medications.

Surgery is most commonly performed when seizures start in one specific area of the brain (partial onset epilepsy). Patients with seizures that begin with electrical activity throughout the whole brain (generalized onset seizures), or from multiple brain areas, are ordinarily not good surgical candidates.

Before surgery is considered, a comprehensive evaluation will be performed. The goal of the evaluation is to identify the exact location where the seizures originate. The pre-surgical testing includes prolonged inpatient video EEG monitoring, MRI, and other tests utilized to pinpoint the location of the brain cells causing the seizures.

A medical team will try to determine if there is a structural brain abnormality triggering the seizures. There are multiple causes for abnormal brain tissue including stroke, head trauma, tumor, infection, abnormal blood vessels, areas of brain that did not develop properly during the fetal period (cortical dysplasia), and genetic conditions.

In addition, before considering surgery, the epilepsy team will perform several tests to be sure that surgery will not result in loss of essential functions, such as speech or memory.

The location of the abnormal brain tissue determines whether surgery is a good option and which technique should be used. The abnormal brain area will be removed or disconnected from the rest of the brain. Prior to surgery, the neurosurgeon will explain to the family the surgical risks and the chance of seizure freedom with surgery.

After surgery, some patients will be completely free of seizures; others will have better control over their seizures. Most patients will remain on medications for at least two years following the surgery.

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