Epilepsy in children

Epilepsy is a brain condition that causes a child to have seizures. It is one of the most common nervous system problems. It affects children and adults of all races and ethnic backgrounds.

The brain is made up of nerve cells that send information to other through electrical activity. A seizure happens when one or more parts of the brain has a burst of abnormal electrical signals that interrupt normal brain signals. Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, alcohol or drug withdrawal, or a brain concussion. But when a child has two or more seizures with no known cause, this is diagnosed as epilepsy.

There are different types of seizures, depending on which part and how much of the brain is affected and what happens during the seizure: focal (partial) seizure and generalized seizure.

Electroencephalogram (EEG)

An EEG records electrical activity in the brain by placing electrodes on your child’s scalp. This helps doctors learn how likely it is that your child has epilepsy and what type of epilepsy they have.

Epilepsy Monitoring Unit (EMU)

See our page about this testing.

Brain MRI

A brain MRI uses magnet fields to create detailed pictures of your child’s brain. This may help find the cause of your child’s epilepsy. During a brain MRI, the patients has to be very still for a long time. Placing the patient under sedation to relax can help them remain still.

Learn about sedated MRI scanning.

Functional MRI (fMRI)

This special type of MRI help find certain motor and language functions located in your child’s brain. Not every patient will need an MRI.

Positron emission tomography (PET)

This special type of CT uses a radioactive tracer to look at how chemicals work inside your child’s brain. As we get ready for your child's epilepsy surgery, we may do a PET to help learn if a certain area of your child’s brain is not working normally. This gives the doctors even more help to know where the seizures are coming from.

Single photon emission computed tomography (SPECT)

This special imaging study uses a radioactive tracer to look at blood flow to your child’s brain, so doctors can know which areas are more or less active. We may have a SPECT if your child has a seizure while in the epilepsy monitoring unit. Or, we may do this test as an outpatient when your child is not having a seizure. The area where your child’s seizures are coming from will usually be more active during a seizure and less active in between seizures, compared to other areas of the brain.

Neuropsychological testing

As part of the work-up for possible epilepsy surgery, this testing may be help us understand your child’s baseline cognitive function. This is the way your child's brain behaves when not having a seizure. A child neuropsychologist first speaks with both you and your child. Then, they do some tests, tasks and puzzles with your child. The doctor will take what they learned during these tests to better understand how seizures may be affecting your child's brain. We then share the test results with your child's neurologist.

Genetic testing

Your neurologist or geneticist may order blood tests. They use a sample of your child's blood to look for common genetic mutations that may cause certain types of epilepsy.

Surgery

We offer every surgical option for pediatric epilepsy. But your child's neurologist should first refer them for testing. We start with testing to find what part of your child's brain may be causing seizures. Depending on findings, we can tailor our treatment based on your child's needs.

We still perform all the normal epilepsy surgeries, such as craniotomies for resection for seizure foci, corpus callosotomies, hemispherectomies and vagal nerve stimulators. But we also offer newer, less invasive procedures such as laser ablation, stereo EEG for invasive monitoring and responsive neurostimulation. Treating patients with epilepsy is not "one size fits all." At Vanderbilt we personalize the care we provide to each patient.

Neurologists should consider referral to our Complex Epilepsy Clinic when patients are not responding to at least two antiepileptic medications. We are happy to evaluate the patients, co-manage their epilepsy while we work through the surgical evaluation, and return your child to their care as desired after surgery or other treatment.

Resective surgery

Sometimes an area of the brain that does not control important bodily function causes seizures. We can treat these seizures by removing or “lesioning” this area of the brain. We can perform this treatment either through open surgery to remove the area, or in some cases with a laser.

Hemispherectomy

In some cases, a child will develop seizures that take over an entire side of the brain. For these challenging problems we perform hemispherectomies to disconnect the two brain hemispheres . This provides excellent results and allows children to resume their normal lives.

Corpus callosotomy

For children with frequent seizures known as “drop attacks,” or seizures that spread rapidly throughout the brain, corpus callosotomy provides reliable relief. In this operation, we disconnect some of the fibers connecting the two brain hemispheres.

Invasive EEG monitoring

Some patients need more invasive testing to find their seizure focus.

There are two types of invasive monitoring.

1. In stereo EEG, a doctor inserts many small electrodes inside the head using small incisions and a robot to help with accurate placement.
2. Subdural electrodes are placed on the brain's surface through a craniotomy (opening in the skull). After either technique for insertion, we monitor patients in the hospital for seizures until detected. Using the information we gather, we plan a surgery to remove the area of the brain causing the seizures.

Dietary treatments 

Ketogenic diets or low glycemic diets may help control seizures.

Vagal nerve stimulation

A device is implanted in the chest to deliver electrical stimulation to a nerve that carries this impulse into the brain. This treatment may help decrease the number or severity of seizures.

Responsive neurostimulation (RNS)

RNS involves a device with electrodes placed directly in the brain. It delivers an electric stimulation at the onset of a seizure to prevent it from spreading and causing clinical symptoms. We may use this device in patients who have seizures coming from more than one area of the brain, or seizures coming from an area that controls normal functions (language, vision, movement of limbs).

Clinical trials

Under the supervision of the Food and Drug Administration, we can prescribe new medicines that may help children who are resistant to commercially available epilepsy medications.