Brain physiology and imaging studies help physicians determine whether a child is a good candidate for epilepsy surgery. They also can help doctors plan surgery so that they remove only damaged brain tissue while avoiding healthy tissue. 

From mapping the brain's anatomy to measuring the electrographic spread of seizures, our diagnostic tests and procedures include:

• 3T magnetic resonance imaging (MRI) with special epilepsy surgery protocol
• Fluorodeoxyglucose positron emission tomography (FDG-PET) with statistical parametric mapping (SPM) analysis
• Ictal/interictal single photo emission computed tomography (SPECT) with subtraction analysis (SISCOM)
• Magnetoencephalography with source localization imaging (MEG/MSI)
• High-density video electroencephalogram (EEG) with source localization
• Functional MRI (fMRI) and EEG-fMRI
• Invasive EEG monitoring with grid placement
• Navigated transcranial magnetic stimulation (TMS) for functional mapping

Neuropsychological evaluations test abilities such as cognition, language, visual-spatial skills, memory, problem solving, motor skills and behavioral functioning.

Neuropsychological evaluations help:

• Understand how epilepsy may affect the child’s behavior and abilities
• Identify problems such as anxiety, depression and learning difficulties
• Recognize side effects from epilepsy medication

Neuropsychological evaluation is best done early in a child’s treatment to help establish a baseline. Then, it is often repeated at regular intervals to help our team monitor how the child is doing.

About 40% of all epilepsy is thought to be due to a genetic cause. Genetic test results can help guide treatment decisions, and indicate whether a child’s siblings or future children might also be at risk for epilepsy. Genetic testing is sometimes definitive, but not always.

Our genetic counselors can:

• Review the child’s medical history and family medical history
• Talk about genetic tests that could be useful
• Schedule and coordinate genetic testing
• Explain what genetic test results mean
• Work with the team to adjust treatment based on genetic test results
• Follow up with families when new genetic tests are available

For the vast majority of children with epilepsy, medication is effective in controlling seizures. Finding the right epilepsy medication—or combination of medications—can be a complex task. 

Our team includes a clinical pharmacist with extensive knowledge and experience in treating children with epilepsy. As part of an initial evaluation, our pharmacist will review your child’s past and current medications, including doses, side effects and interactions with other medications, over-the-counter products or supplements he or she may be taking. 

Recommendations may include adjusting doses, combining different anti-epilepsy medications or trying something new to help control seizures and minimize side effects. Our team monitors each child to evaluate how well the medication or medications are working, and makes adjustments as needed. 

Specialized diets can help some children achieve seizure control when anti-seizure medications are not effective. These diets include the ketogenic diet and the modified Atkins diet, both of which are high in fat, low in carbohydrates and have a moderate amount of protein. 

These diets may benefit children with epilepsies who have not responded to several different seizure medicines, children who aren't surgical candidates due to the location of the seizure focus or other factors, and children who have specific conditions including:

• Lennox Gastaut syndrome
• Infantile spasms (West syndrome)
• Rett syndrome
• Tuberous sclerosis complex
• Dravet syndrome
• Doose syndrome
• GLUT-1 deficiency

Studies show that up to two-thirds of children who follow one of these diets are helped by it. Some eventually may be able to decrease the dose of their anti-seizure medications or discontinue their medications altogether.

Our team monitors children closely for possible side effects of the diets, such as constipation, and are available to answer questions and provide long-term support.

For 5-10 percent of children with epilepsy, surgery may be necessary. The goal of surgery is to dramatically reduce the severity and frequency of seizures and, when possible, eliminate them altogether.

The surgical team at Cincinnati Children’s creates detailed cortical maps, identifies the seizure foci (or starting points), evaluates electrical and magnetic waveforms in the brain, and measures the electrographic spread of seizures within hundredths of a second. 

We typically begin considering surgery if your child has seizures that have not responded to two or more anti-epileptic medications.

Our surgical treatment capabilities include:

• Craniotomy and Electrode Placement / Intracranial Monitoring
• Robotic-assisted stereotactic implantations for invasive sEEG monitoring
• NeuroPace RNS^® System
• Resective / Ablative Surgery
  • Lobectomy (Lobar Resection)
  • Multilobar resection
  • Cortical Resection (Corticectomy)
  • Hemispherectomy or Hemispherotomy
  • Laser Ablation
• Palliative (non-curative) Surgery
  • Corpus Callosotomy
  • Implantation of Vagus Nerve Stimulator
  • Multiple subpial transections

Children with epilepsy are at risk for learning difficulties, developmental delays, depression, anxiety and behavioral issues. Sometimes these difficulties are related to seizures. Sometimes they are medication side effects. Sometimes they are a part of the child’s development, independent of epilepsy and its treatment.

We help children and families recognize these concerns and deal with them in a healthy way so they can enjoy the best quality of life possible. That is why clinical psychologists are part of our clinical care. They provide assessments, brief treatments, family education and, if needed, referrals for outpatient psychological care.