Epilepsy Treatments
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Seventy percent of people with epilepsy can control their seizures through available treatments, reports the National Institute of Neurological Disorders and Stroke -- and the outcomes are often even better for children, because they often outgrow the condition. Depending on your child's type of epilepsy, her neurologist will likely use one (or a combination) of the following approaches.
Medication
Anti-epileptic drugs can provide complete seizure control for more than half of all patients with epilepsy and reduce seizure frequency in another 20 to 30 percent, reports the Epilepsy Foundation. That's why "antiepileptic drugs are always our first line of defense," says Orrin Devinsky, M.D., a neurologist and director of the NYU Comprehensive Epilepsy Center at NYU Langone Medical Center. The specific medication or medications will depend on your child's case, but some of the most effective antiepileptic drugs are carbamazepine (such as Tegretol), oxcarbazepine (Trileptal), levetiracetam (Keppra), lamotrigine (Lamictal), ethosuximide (Zarontin), gabapentin (Neurontin), and valproic acid (Depakote). These drugs are effective but they cause a range of side effects, including weight gain, fatigue, irritability, dizziness, stomach trouble, and feeling "foggy." "It's always our goal to use one drug at the lowest possible dose," Dr. Devinsky explains. "But many children need multiple drugs to control their seizures -- that's when we get into trouble with side effects." The good news is that although a few forms of epilepsy require lifelong medication, in most cases as children reach the age where they are likely to outgrow their seizures, your neurologist may be able to begin weaning them off their medications.
Diet
About one third of children with epilepsy who follow a high-fat, low-carb ketogenic diet become completely seizure-free, while another third experiences significantly fewer seizures. (One third sees no improvement.) Given that kind of track record, you may wonder why doctors don't prescribe dietary changes before trying medication, but "it's hard to tell a kid that he can only have 15 grams of carbohydrate per day and yes, Brussels sprouts count!" Dr. Devinsky says. "There is no bread, no pasta, no pizza. These diets seem to work, but we don't understand why, and they are challenging to sustain."
To begin a ketogenic diet, your child may be hospitalized for a 24-hour fast, so his body will use much of its stored glucose. Then a nutritionist will work with your family to plan meals for your child that contain 80 percent fat and only small amounts of protein and carbohydrates. The ketogenic diet can cause constipation, dehydration, and even kidney stones, so it's important that your child's diet be supervised and monitored closely by his medical team. If the full ketogenic diet is too hard for your child to follow, your nutritionist may prescribe a modified Atkins diet, which is still very low-carb but contains more protein and may be better for overall health; its impact on epilepsy appears very similar to the ketogenic diet. Either way, you'll need to try the diet for one to three months before you can determine whether it's working. If it seems to help, doctors usually prescribe it for up to two years.
Surgery
Surgery is a last resort for children with epilepsy who have not responded to multiple medications or dietary changes. "We look at surgery when a child's quality of life is dramatically impacted by his seizures or by the side effects of the medication he requires to stay seizure-free," Dr. Devinsky explains, noting that it can be safely performed over the age of 6 months and, in severe cases, even earlier. The best candidates for epilepsy surgery are patients whose MRI identifies a particular focus, or part of the brain that appears to be causing their seizures, because a neurosurgeon can treat or (in very serious cases) remove the affected section.
If your child is not a candidate for that kind of curative surgery, she may benefit from having palliative procedures, such as placement of a vagus nerve stimulator. This device works "like a pacemaker for your brain," explains Phillip Pearl, M.D., director of epilepsy and clinical neurophysiology at Boston Children's Hospital. "It can help to decrease seizure frequency," Dr. Pearl says. "There are other emerging methods involving brain stimulation that are also very promising for the treatment of epilepsy."
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