The Pediatric Regional Epilepsy Program (PREP) cares for children of all ages and with all types of seizures and epilepsy. Some children seen through PREP may not have seizures at all, but rather have tics, fainting spells, normal movements in sleep or other conditions that can be confused with seizures.
Most children seen through PREP have definite seizures that respond well to medication. Some children have seizures that do not respond well to medical treatment and may need an epilepsy second opinion from a PREP physician regarding other treatment options. This may include reassurance and continuation of ongoing treatment with small adjustments, a trial of alternate medications including use of investigational drugs, and/or alternate options such as ketogenic diet, vagus nerve stimulation (VNS) or epilepsy surgery.
The PREP team tailors each treatment plan to best serve the patient and their family.
The evaluation starts with a medical history, a developmental history, a physical exam and a neurological exam. An EEG is almost always needed. Some children need a brain MRI scan. Usually no other tests are needed.
If treatment for seizures is indicated, medication is almost always the first step.
If treatment with a few seizure medications is not successful, other options to consider include:
Children with seizures who are not successfully treated with medication and who are not candidates for epilepsy surgery can be considered for the ketogenic diet. This very high-fat diet has been used for many decades, and seizure-free rates of up to 25 percent have been reported. The diet requires a team approach, with expert input from neurologists, dietitians, skilled nursing staff and gastroenterologists.
If your child is not already under the care of CHOP neurologist, and you would like to explore the possibility of the ketogenic diet, then contact PREP for a second opinion consultation.
Vagus nerve stimulation (VNS) is another treatment option for children who do not respond to medication, are not candidates for epilepsy surgery, and will not tolerate or have not responded to the ketogenic diet. How the VNS works is unknown. Complete control of seizures cannot be expected with the VNS, but approximately 50 percent of patients have a 50 percent reduction in seizures after 1-2 years. In some children, seizures are shorter, or the postictal state is less disabling; some seizures can be aborted by activation of the VNS during the aura.
If your child is not already under the care of CHOP neurologist, and you would like to explore the possibility of VNS treatment, contact PREP for a second opinion consultation.
Epilepsy surgery is often considered when seizures do not respond to medication and the seizures start in a part of the brain that could be safely removed. In general, children with epilepsy who have not responded well to 2 or 3 trials of medication should at least be be considered for possible epilepsy surgery.
Initial evaluation includes taking a detailed history of the nature of the seizures, performing a neurological exam to look for clues regarding where seizures may begin, performing a brain MRI scan and a brain MEG scan, recording some seizures in the epilepsy monitoring unit and neuropsychological testing.
Once these tests are completed, your child's neurologist will meet with you and your child. You'll also meet with CHOP's epilepsy surgeon, Phillip Storm, MD, to further discuss the options for epilepsy surgery. In some patients, the chances of becoming free of seizures after surgery are as high as 70 to 80 percent. Other patients have about a 50 percent chance of becoming free of seizures after surgery, but may have fewer seizures or less severe seizures.
The decision to proceed with epilepsy surgery is usually a difficult decision for families. But for some patients, epilepsy surgery is a wonderful option. The evaluation of any child for epilepsy surgery requires a team approach, with input from specialists in epilepsy, EEG, neuroradiology, neuropsychology, and neurosurgery — and, of course, ongoing input from patients and families. The PREP team is experienced in performing epilepsy surgery in children of all ages and with all types of epilepsy.
If your child is not already under the care of CHOP neurologist, and you would like to explore the possibility of epilepsy surgery, then contact PREP for a second opinion consultation.