Epilepsy in Children

We start with a conversation. Talking about your child’s symptoms, seizures and experiences helps us get to know all of you. We’ll ask you a lot of questions. It’s all part of getting to know you and your child. Please be ready to talk about your child’s medical history and your family’s medical history. We may do a physical and neurological exam. There might also be a few tests to get a good look at what’s going on inside your child’s brain. These can include an MRI and an EEG to see where in their brain the seizures are starting. This might seem like a lot of testing, but it’s an important part of the process and helps us gather all the information we need.

In order to make a diagnosis, or to see if surgery is an option for your child, your provider may do several more detailed tests, like:

• Video EEG: This test takes a video of your child during their EEG to see what goes on when a seizure happens.
• Magnetoencephalography (MEG): This test is the most advanced way of recording and evaluating your child’s brain while it’s working. It’s a noninvasive, painless test that uses sensitive magnetic sensors attached to a helmet (picture a hair dryer hood from a salon) to detect epileptic activity in a specific part of their brain.  
• Positron emission tomography (PET scan): This test helps find the part of your child’s brain that’s causing the seizures. It measures energy use and metabolism in different areas of their brain.
• Ictal single-photon-emission computed tomography (Ictal SPECT): This test measures blood flow in your child’s brain and shows how this flow changes with a seizure.
• Voxel-based morphometry: This is a unique type of MRI that uses computer data to detect hard-to-find areas of the brain which might be contributing to epilepsy. This is especially useful when the results of a regular MRI aren’t clear.
• 7-Tesla (7T) MRI: Cleveland Clinic is one of only a few healthcare institutions in the U.S. that offers this advanced imaging technology. A 7T MRI shows brain tissue more precisely than more widely used 3-Tesla MRIs.

Pediatric epilepsy monitoring unit

If your child’s seizures need to be watched around the clock, they can stay in a private room in our Pediatric Epilepsy Monitoring Unit. Hundreds of children are evaluated each year in the unit, which operates 24 hours a day, seven days a week.

We’ll use video EEG equipment to keep tabs on their brain’s activity and video cameras to record their body movements during a seizure. We’ll watch your child closely for about three to seven days, depending on the testing their provider orders. This extended stay gives their provider and care team a much better understanding of their seizures, which can help with diagnosis and designing the best possible treatment plan.

The goal of epilepsy treatment is to stop or lessen your child’s seizures. This involves a personalized treatment plan that we put together based on what your child needs. We know that everyone who sees us is unique, so you won’t find a one-size-fits-all solution here. The treatment plan for your child will be based on their diagnosis, age and overall health. Treatment options we might recommend can include:

Medication

The kinds of anti-seizure medications we recommend depend on the type of epilepsy your child has. The dose will vary with age, weight, sex and other factors. It may take several tries to come up with the best combination of medications or dosage. We’ll check in with you and your child while we dial in the correct medication for them. During this adjustment period, we may do blood tests to see how your child’s body is reacting to the medications.

Ketogenic (Keto) diet

Food can have a major impact on our lives. Sometimes changing what your child eats may help reduce or control their seizures. The Keto diet lowers the amount of carbs your child eats and teaches their body to burn fat for energy instead. Low sugar and high fat makes the brain less excited and reduces the tendency to have seizures. Your provider can tell you if a Keto diet would be helpful for your child.

Surgery

We know surgery can be a very scary word — especially when it’s your child having the surgery. Rest assured that our epilepsy surgeons are among the best in the world. Epilepsy surgery is a safe and highly effective way to treat seizures if medications or other less invasive methods don’t work. Children actually are often good candidates for epilepsy surgery because their brains are still developing, so they can heal more easily.

But deciding to do surgery is a big decision. It’s followed by many conversations with you and your family and testing. When surgery is on the table, your epilepsy team will meet to talk about your child’s test results and decide if surgery is an option for your child. Then they’ll meet with you to go over their recommendation. They’ll explain the procedure, answer your questions and talk about your concerns.  

Depending on how old your child is, we’ll also help them prepare by explaining what’s going to happen before, during and after surgery. We’ll talk with them about any fears they might have and answer their questions. We can even give them a tour of the pediatric monitoring unit and the operating room.

The most common types of surgery for children with epilepsy include:

• Lesionectomy: This procedure uses MRI pictures to target and remove whatever’s causing the seizures (like a tumor).
• Lobectomy: In this procedure, the surgeon removes a lobe (part of the brain) where the seizures start. Tests before surgery will make sure the procedure won’t affect any of your child’s vital functions (like speaking or moving).
• Hemispherectomy: In this surgery, half of the brain is either totally or partly removed or disconnected from the other half. This procedure is usually only done when the affected hemisphere (half) is already damaged or isn’t working the way it should for other reasons.
• Corpus callostomy: During this procedure, the surgeon separates the two hemispheres (halves) of the brain so that the main bundle of connections between them can’t send seizure signals from one half to the other.
• Deep Brain Stimulation (DBS): This procedure involves putting a device in the brain that sends electrical signals to disrupt a seizure.
• Laser Interstitial Thermal Therapy (LITT): This minimally invasive procedure uses a laser (tiny probe) to target and destroy the brain tissue where the seizures happen. 

Pregnancy and Epilepsy

Pregnancy might seem like it’s a long way off. But your provider might talk to you and your child about planning for that future now. Some commonly used medications to treat epilepsy and seizures can affect your child’s birth control, pregnancy, hormone levels and reproductive cycle.

People with epilepsy or seizures can go on to have healthy pregnancies with some extra planning and teamwork. It’s important that your child receives the right care by working closely with their epileptologist and obstetrician/gynecologist (ob/gyn).

Taking the Next Step

Childhood should be about having fun — not having seizures. If your child has epilepsy, we can help. Working together, we can craft a treatment plant that fits your child’s life. This might mean a lot of testing and talking about options. But we’ll be there with you every step of the way. We’ll give your child the expert and compassionate care they need as soon as possible, so they can get back to the fun part of just being themselves.