Introduction
Epilepsy is a neurological disorder causing recurrent and unpredictable seizures that can be challenging for a person's daily life and cause various risks to their health and well-being. Epilepsy can affect individuals of all ages; however, for children and their families, it is very difficult to handle. Pediatric epilepsy surgery can be performed to treat a selected group of pediatric patients whose seizures are not controllable by medications. The appropriate individual selected for pediatric epilepsy surgery should meet several criteria. In patients who meet the requirements for epilepsy surgery, the results can be very positive, with very few side effects and complications.
What Is Epilepsy?
Epilepsy is a neurological disorder that affects the brain's electrical activity, causing recurrent seizures. Seizures manifest as brief, subtle episodes or prolonged, convulsive events. It can vary in type and severity. Seizure episodes can occur due to excessive electrical discharges in a group of brain cells. Various factors, including genetics, infections, brain injuries, or structural abnormalities in the brain, can cause epilepsy. In children, epilepsy can be challenging, as it can affect their cognitive development, education, and overall well-being.
In pediatric epilepsy, early diagnosis and treatment are vital to providing the best possible outcome for the child. The first-line treatment for epilepsy often involves medications. However, medication will not be effective for all children, and some may experience seizures even after taking multiple medications. In such cases, pediatric epilepsy surgery becomes a viable option.
Who Are Eligible Candidates for Pediatric Epileptic Surgery?
Pediatric epileptic surgery is indicated for a limited group of children. It usually takes two or three antiepileptic medication trial failures before considering a child as a potential candidate for surgery. This decision is taken only after two or three years of continuous medication treatment.
The medication failure may occur due to the following reasons.
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Resistance to the available antiepileptic medication.
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Side effects of the antiepileptic medication.
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Or a combination of both.
Since epileptic surgery might be very effective in some children, once it is clear that antiepileptic medication is not working effectively for a child, surgery should be considered. Epilepsy surgery is most appropriate for stubborn, frequent seizures that start in one location in the brain (focal) due to scar tissue, tumor, cyst, or another lesion that can be addressed through surgery. Surgery can be performed at a very young age, and there is no advantage in waiting for the child to be older. Also, at a young age, there is a certain degree of plasticity in the brain, which aids with the recovery of damage caused during surgery. This plasticity is higher in young kids than in older children.
What Are the Different Types of Pediatric Epilepsy Surgery?
Pediatric epilepsy surgery consists of various surgical procedures that help control or eliminate seizures in children. The choice of surgery depends on various conditions, including the type of seizures, their frequency, and the underlying cause. Some common types of pediatric epilepsy surgery include:
1) Focal Cortical Resection - This is the most common type of pediatric epilepsy surgery. It is typically performed when seizures originate from a specific area in the brain. The surgery aims to remove the source of the seizures while preserving the nearby brain structures that are vital for specific functions. It is an open surgery, making a temporary window in the skull. Intraoperative electrode recordings and computer-assisted neuronavigation optimize the safety and efficacy.
2) Hemispherectomy - Hemispherectomy is a surgical procedure that completely or partially removes and disconnects almost an entire half of the brain. It is also known as hemidecortication or functional hemispherectomy. It is performed in cases of more severe seizures that originate from one hemisphere of the brain. Hemispherectomy has been a very successful type of seizure surgery for very few children. The risks of hemispherectomy include hydrocephalus (abnormal buildup of cerebrospinal fluid in the brain) and infection.
3) Corpus Callosotomy - This surgical procedure is typically used for children with severe generalized seizures that start on either side of the brain and spread. This procedure involves severing the corpus callosum, the fibers connecting the brain's two halves. When the two hemispheres are disconnected, the spread of seizures in the brain from one side to the other can be stopped. After surgery, there may be temporary or permanent limitations in the movement of certain body parts and speech or behavior alteration. So, parents need to be informed of these complications.
4) Vagus Nerve Stimulation - Vagus nerve stimulation is done by vagus nerve stimulator (VNS). It is a device that regularly sends out electrical signals. This stimulator is mostly used when the patient has multiple or widespread sources of seizures. Intermittent electrical signals are sent to the brain by this device to interrupt the spread of a seizure.
The VNS is surgically placed in the upper chest below the collarbone and connected to an electrode attached to a nerve in the neck called the vagus nerve. The number and severity of seizures can be reduced by stimulating the vagus nerve. The device is stimulated automatically throughout the day and night. Manual activation of the stimulator can be done in case of a seizure.
5) Responsive Neurostimulation (RNS) - It is a relatively new invention in which a device is attached to the brain to continuously monitor the brain's activity and deliver targeted electrical stimulation when any abnormality is detected.
Conclusion
Pediatric epilepsy surgery can provide hope for children and their families who are fighting with the complications of epilepsy. However, surgery is not the first line of treatment for epilepsy; it is considered when two to three trials of antiepileptic medication fail, or the quality of life is significantly affected by the condition. The decision to pursue surgery must be made in consultation with a team of experts who consider the individual child's condition and needs.
