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TREATMENT
MEDICATIONS
Once epilepsy is diagnosed, it is important to begin treatment
as soon as possible. For about 80 percent of those diagnosed with
epilepsy, seizures can be controlled with advanced medications
and surgical techniques.
Children are not just little adults -
the way a child's body uses a medicine, the length of time it
takes for the medicine to leave
the child's body, the side effects that the child will experience,
and the effects on a growing child's physical and mental development
all may differ from the way the same medicine would affect an
adult. Epilepsy is even more complex to treat because a child's
seizures
may be different in cause or effect from an adult's seizures,
even if they look similar. This is why it is very important that
children
with epilepsy are seen in a program that has extensive expertise
in treating pediatric patients.
In recent years, a number of new
drugs have become available. For most people with epilepsy, seizures
can be controlled with just
one drug (monotherapy) at the optimal dosage. Combinations of
drugs are sometimes prescribed if monotherapy fails to effectively
control
a patient's seizures.
VAGUS NERVE STIMULATION (VNS)
The VNS is a medical device that is surgically implanted under
the skin on the chest wall. Two small wires from the device wrap
around the vagus nerve. The stimulator provides intermittent,
mild pulses of electrical energy through the vagus nerve to the
brain. When a student senses the impending onset of a seizure,
the student or school staff can activate
the device through a hand-held magnet to deliver an additional
dose of stimulation. The VNS is utilized in those students who
fail to obtain seizure control with antiepileptic medications.
KETOGENIC DIET
The ketogenic diet consists of mostly fats with little or no carbohydrates
and a minimal amount of protein. A student on the ketogenic diet
is followed closely by a physician and a dietitian. The diet
is labor
intensive requiring careful weighing and measuring of food and
strict compliance. When the body metabolizes its own fats and proteins,
a chemical substance called ketone bodies is produced, thus the
name ketogenic diet. This diet is most often utilized in children
18 months to 9 years of age whose seizure disorder is not controlled
through the use of antiepileptic medications.
SURGERY
When medication is not effective surgery is considered as an option.
A thorough evaluation will determine if the patient is a candidate
for surgery. The primary objective of most epilepsy surgical
procedures is to accurately localize and then completely remove
the region of the brain responsible for the seizure without causing
cognitive or neurological deficit.
Surgical options include:
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Lesionectomy – If the recurrent seizures
are found to be caused by small lesions such as cavernous
angiomas, lowgrade
astrocytomas, cortical dysplasias and areas of focal atrophy,
they
may be successfully removed. Lesionectomy is associated with
excellent results and success rates are generally better than
those associated
with surgery performed in patients without discrete lesions.
-
Temporal
resection – This procedure removes part of the
temporal lobe of the brain where the epilepsy seizures originate.
If patient selection is appropriate, surgery in the temporal
lobe offers good to excellent results in 75% to 85% of the cases.
-
Extra-Temporal
resection – This is less commonly performed
and the success rate is lower than temporal lobes resections.
-
Intracranial Monitoring – Sometimes
the seizure focus cannot be determined. In this instance,
diagnostic surgical options
may
be recommended. This involves implanting electrodes into the
brain, providing more precise EEG information due to the closer
proximity
to the seizure focus area.
-
Hemispherectomy – This procedure
is reserved for patients with severe epilepsy with widespread
independent epileptic discharges
in one hemisphere, often extending to the normal hemisphere.
This procedure involves removing most or all of one of the brain’s
hemispheres. This procedure has grown in sophistication over
the years and has yielded impressive results. But again, it
is only
reserved for a very select group of patients.
-
Corpus Callostomy – This
surgery has been offered as an alternative to hemispherectomy
in epileptic patients, but
is not
as effective as hemispherectomy. This surgery involves removing
the corpus callosum of the brain.
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