Epilepsy is a brain condition that causes a child to have seizures. It is one of the most common disorders of the nervous system. It affects children and adults of all races and ethnic backgrounds.
The brain consists of nerve cells that communicate with each other through electrical activity. A seizure occurs 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, which depend on which part and how much of the brain is affected and what happens during the seizure: focal (partial) seizure and generalized seizure.
How we diagnose epilepsy
An EEG is a non-invasive test that records electrical activity in the brain by placing electrodes on your child’s scalp. An EEG helps your neurologist determine the likelihood of your child having epilepsy and what type of epilepsy they have.
Epilepsy Monitoring Unit (EMU)
See our FAQ page about this testing.
A brain MRI uses magnet fields to create detailed pictures of your child’s brain. This may help determine the cause of your child’s epilepsy. A brain MRI requires patients to be very still for a long period of time, so we may need to sedate them for this test based on age and development.
Functional MRI (fMRI)
This special type of MRI may be obtained prior to epilepsy surgery to help determine where certain motor and language functions are located in your child’s brain.
Positron emission tomography (PET)
This special type of CT uses a radioactive tracer to look at your child’s chemical brain function. As part of the work-up for epilepsy surgery, we may obtain a PET to help determine if a certain area of your child’s brain is not functioning normally. This provides additional support about where the seizures are coming from.
Single photon emission computed tomography (SPECT)
This special type of imaging study uses a radioactive tracer to look at blood flow to your child’s brain and determine which areas are more or less active. A SPECT may be obtained during an EMU admission when your child has a seizure (ictal SPECT) or as an outpatient when your child is not having a seizure (interictal SPECT). 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.
As part of the work-up for possible epilepsy surgery, neuropsychological testing may be helpful in understanding your child’s baseline cognitive function. A child neuropsychologist first speaks with both you and your child, then conducts a series of tests, tasks and puzzles that are later analyzed and interpreted. We then share the results of this testing with your neurologist.
Your neurologist or geneticist may order blood tests to look for common genetic mutations known to be associated with certain types of epilepsy.
How we treat epilepsy
We offer every surgical option for pediatric epilepsy. This begins with a thorough evaluation for localization of seizure onset. Depending on findings, we can tailor our treatment based on your child's individual needs.
Patients should be referred for our thorough and timely epilepsy surgery evaluation. We still perform all the traditional epilepsy surgical interventions, such as craniotomies for resection for seizure foci, corpus callosotomies, hemispherectomies and vagal nerve stimulators. But we also offer newer, minimally 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 the patient to their care as desired after surgical evaluation or treatment.
Sometimes an area of the brain that does not control important bodily function causes seizures. We can treated these seizures by removing or “lesioning” this area of the brain. We can performed this treatment either through open surgery to remove the area, or in some cases through minimally invasive techniques with a laser to lesion the area.
In some situations, children develop seizures that take over an entire side of the brain. For these challenging problems we perform hemispherectomies where the entire brain hemisphere is disconnected. This provides excellent epilepsy results and allows children to resume their normal lives.
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.
- Stereo EEG is a technique of inserting multiple small electrodes inside the head using small incisions and a robot to assist with accurate placement.
- 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.
Ketogenic diet 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)
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.