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Diagnosis
In addition to a comprehensive physical examination and analysis of the child's medical history, the physician may conduct an electroencephalogram (EEG) to record electrical activity in the brain or an MRI scan of the brain to identify the precise location of abnormal electrical activity. The source of epileptic seizures differs within each child's brain.
Significant technological advances have greatly improved the diagnostic accuracy for children with epilepsy. University of Chicago scientists and neurologists pioneered multimodal imaging techniques which provide a detailed look at electrical activity inside the brain and pinpoint the source of abnormal activity. By combining several different imaging techniques, multimodal imaging enables physicians to create a "map" of the brain's electrical activity. During surgery, this map is imposed right on the child's brain to guide the neurosurgeon's procedure. This diagnostic accuracy helps to protect the child's delicate brain structures throughout surgery.
Treatment Options
Fortunately, many children respond well to epilepsy treatment. Penn State Hershey neurologists use all approved drug therapies to treat children with epilepsy. After several years of treatment, some children seem to outgrow epilepsy and are able to discontinue anti-convulsant medication.
Children with severe epilepsy and a well-defined focal point causing erratic electrical brain activity may be candidates for surgical treatment. Depending on the focal point's location, highly trained Penn State Hershey neurosurgeons may be able to remove the damaged section of brain tissue without impairing the child's brain function.
Previously, neurosurgery was postponed until children passed puberty and both the body and brain reached near-maturity. However, epilepsy specialists now know that better results can be achieved when surgery is performed on younger children. Because children are still growing, their brain cortex can rearrange and repair itself after surgery. Children with severe epilepsy are evaluated for surgery as early as possible at Penn State Children's Hospital. By reducing or eliminating seizures at a younger age, children are spared the side effects of long-term anti-convulsant medications and frequent seizures. (Frequent seizures and strong medications can impair a child's intellectual, social and physical development.)
Vagus Nerve Stimulator
For patients who are not candidates for surgery, a new therapeutic option at Penn State Children's Hospital uses a vagus nerve stimulator to control seizures in patients. The vagus nerve stimulator works similarly to a pacemaker. It delivers intermittent electric pulses 24 hours a day to the brain through a wire in the neck connected to the vagus nerve. In addition, when a patient senses the impending onset of a seizure, he/she can activate the device through a hand held magnet to deliver an additional dose of stimulation.
Craniotomy
A craniotomy is the surgical opening of the skull, usually by creating a flap of bone.
Stereotactic Array
When a child has intractable epilepsy, a surgeon sometimes can remove an abnormal segment of the cerebral cortex, eliminating or drastically reducing the number of seizures. But some patients with these seizures have brains that look perfectly normal. To enhance our ability to find abnormal tissue, our researchers use a phased array of coils - an electromagnetic receiver that fits on the head like a hat - to direct their MRI scan to a region. Using this new tool it is possible to detect they found a subtle malformation occupying a space as small as a cubic centimeter. Surgeons can remove these tiny spots using a "stereotactic array," a device that allows them to use MRI to locate the segment precisely.
For Surgery - Identifying the Seizure Source
In order to identify the exact site in the brain where epileptic seizures originate, neurologists must study the child's seizures as they occur. This diagnostic process is detail-focused and time-consuming. Children are admitted to Penn State Children's Hospital for up to two weeks, where anti-convulsant drugs are gradually withdrawn so that seizures will occur with more frequency and severity. Then, the child's brain eactivity is recorded during repeated seizures. Of course, patients are closely monitored as seizures occur in the hospital setting.
Ketogenic Diet
At times epileptic patients are placed on a special diet which can reduce the number of seizures.
