Epilepsy

Treatments We Offer

With the information we gather during your child’s evaluation, our epileptologists (doctors with special training in epilepsy care), neurologists, neurosurgeons, neurophysiologists, neuropsychologists, psychiatrists, and neuroradiologists work together to customize your child’s treatment. Your child’s treatment may include:

Medical Therapy

• Antiseizure medications. These drugs are effective in about two-thirds of children with epilepsy. We'll try a variety of medications to see if we can find one that works well for your child.
• Investigational therapies. Your child may be eligible to participate in a clinical trial of a new epilepsy treatment. Our researchers have played a significant role in the development and assessment of most of the new antiseizure mediations available today. We continue to conduct clinical trials of new epilepsy drugs.

Dietary Modifications

Some children with epilepsy benefit from dietary changes that can reduce the frequency of their seizures. We offer nutritional guidance for epilepsy, such as how to follow a high-protein and high-fat ketogenic diet, a low glycemic index diet, or a modified Atkins diet. Our registered dietitian can teach you how to incorporate new dietary changes into your child’s life.

Vagus Nerve Stimulation (VNS)

We use VNS for some children and adults with epilepsy whose seizures are not well controlled with medication. We have the most experience in the mid-Atlantic region with VNS—a small pacemaker-like device implanted under the skin in the chest which sends small electrical impulses to the left vagus nerve to control seizures.

Surgery

The goal of epilepsy surgery is to reduce or eliminate seizures in children whose condition is not well controlled with medication. Because of advances in brain imaging, we can now recognize subtle structural brain abnormalities that cause epilepsy. As a result, certain children and adults are now candidates for epilepsy surgery who may not have been considered for this treatment in the past. In some cases, surgery can actually cure epilepsy. In other cases, surgery may reduce the frequency and severity of seizures. Since uncontrolled seizures can lead to irreversible effects on cognitive and functional development, and in some cases be life threatening, surgery for epilepsy can be life-saving.

If your child is a candidate for epilepsy surgery, the team will first locate the source of the seizures to determine the type of surgery that will offer the best chance for a cure. This involves finding the exact source of the seizure activity, a process that includes high resolution MRI brain imaging, EEG tests, video-EEG monitoring, and the epilepsy team’s comprehensive evaluation of the patient.   Some patients may also undergo intracranial monitoring to determine the exact source of the seizure activity.

Minimally Invasive Epilepsy Surgery

For children with clearly localized seizure sites (foci) that may be difficult or risky to access with traditional surgery, we offer several minimally invasive techniques, laser interstitial thermal therapy (LITT), also known as laser ablation, and stereotactic radiosurgery (SRS). Using computer-guided navigation, both of these techniques allow the surgeon to attempt to eliminate the seizure focus without making a large opening in the skull. Aided by MRI, the surgeon guides a laser through a three-millimeter incision and into the focus of a seizure to destroy the brain tissue causing seizures. Most children are able to go home the next day.

Traditional Epilepsy Surgery

For many children with epilepsy, their best chance of becoming free of seizures is to identify and remove the area of the brain where their seizures are arising. Our surgeons perform these surgeries with great success and have pioneered new techniques. We use brain mapping before and during surgery to carefully define regions of the brain near the area being considered for surgery. We may interrupt nerve fibers on the surface of the brain that carries the signals causing epilepsy symptoms or remove the specific area of the brain that is triggering seizures.

Innovative Approaches to Pediatric Hemispherectomy for Catastrophic Epilepsy

In the past, surgical treatment for children with catastrophic (medically refractory, severe and disabling seizures) epilepsy was considered only after a long period of seizures and multiple medication trials. Today, children who will develop catastrophic epilepsy can be identified earlier. For instance, we know that certain conditions of infancy lend themselves to this procedure, such as perinatal stroke; Sturge-Weber Syndrome; hemimegalencephaly, a rare neurological condition in which one side of the brain is abnormally larger than the other, and Rasmussen’s Encephalitis.

At NewYork-Pesbyterian, pediatric neurosurgeons are developing innovative approaches to pediatric hemispherectomies, a broad category of surgical resection and disconnection procedures that are performed to treat children with catastrophic epilepsy that often arise from a single hemisphere of the brain and can result in severe impairment.

Pediatric hemispherectomies are performed in children as young as one or two years of age or even in infancy. The ideal age for this procedure depends on the child’s overall health and the severity of his or her epilepsy.