Treatment Options

More than 25 percent of all children with seizures prove to be unresponsive to medications. Either these seizures cannot be managed solely through medication or the side effects from the anticonvulsant medications are unacceptable. Because of our reputation for handling complex cases effectively, many of our patients are in this category. There are four options for these patients –medication changes, dietary control, vagal nerve stimulators, and resective surgery. Selecting among these possibilities is the next step in a child's care, and recommendations are made after input is received from the entire epilepsy team. Depending upon which paths are taken, the child may undergo additional testing, have his or her medications changed, or both. All of your options will be discussed with you in detail so they are understood.

Optimal medical management

For some patients, neither surgery nor stimulator placement are good options. These individuals are best treated with optimized medical management or the ketogenic diet. In these cases, our vast experience with anticonvulsants and research in medication selection is clearly beneficial. In addition, the Pediatric Epilepsy Center maintains a comprehensive database of patient responses to medication. This information can help guide the epilepsy team in selecting medication and reducing unwanted side effects.

Vagal nerve stimulators

On occasion, the patient whose epilepsy is resistant to anticonvulsants is not a candidate for resective surgery. A recently introduced alternative is the vagal nerve stimulator. As with cardiac pacemakers, the vagal nerve stimulator is implanted beneath the skin (minimally invasive surgery). The epilepsy team, which has used this device with patients from two years of age through adulthood, has the experience necessary for selecting patients most likely to benefit with this alternative. We have found that patients with Tuberous Sclerosis and "drop" attacks are more likely to respond to this therapy. As a result of our experience, University of Chicago Hospitals patients using this modality have enjoyed much greater improvement than the national average.

Epilepsy surgery

For the many children with intractable seizures, the only available cure is surgical resection. The University of Chicago, along with other leading university centers, encourages "early intervention" since the young brain recovers more completely after surgery. Also, when the number of seizures is reduced or eliminated at a younger age, children are spared the side effects of frequent seizures and of long-term exposure to anticonvulsant medications. At the University of Chicago Hospitals, surgeons have been performing epilepsy surgery for nearly 20 years with excellent results, and advances in preoperative diagnostic imaging continue to improve surgical outcomes. For those patients where surgery is a viable option, our pediatric epilepsy neurosurgery team provides a complete range of safe and effective surgical interventions and alternatives, including cortical topectomy, subpial transection, corpus callosotomy, implanted stimulator, functional or anatomical hemispherectomy, and lobectomy.

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