Intractable Epilepsy

What is seizure?
Another name for seizure is convulsion. A seizure is a paroxysmal, time-limited change in motor activity and/or behavior that results from abnormal electrical activity in the brain.

During a seizure, your child may:
become stiff
become unconscious or not know where they are
have jerking or twitching movements
have the eyes roll backward
Stare into space
have noisy breathing
after the seizure, your child may be sleepy and confused for a while.

Seizures are common in the pediatric age group and occur in approximately 10% of children. Some seizures in children are provoked by somatic disorders originating outside the brain, such as high fever, infection, syncope, head trauma, hypoxia, toxins, or cardiac arrhythmias. Some seizures do not have any provoking factors. Other events, such as breath-holding spells and gastroesophageal reflux, paroxysmal vertigo (dizziness), night terrors, and rage attacks, can simulate seizures.

What is epilepsy?
Epilepsy is considered when two or more unprovoked seizures occur at an interval greater than 24 hr apart. Therefore, having a seizure does not necessarily mean that a person has epilepsy. Less than one third of seizures in children are caused by epilepsy.

What is intractable or uncontrollable epilepsy?
Patients who have intractable epilepsy are those who have tried two or more medications and are still not satisfied with seizure control, side effects, or their quality of life.

What are the treatments for the intractable epilepsy?
Surgery: The goal of surgery is to remove the location within the brain that causes the seizures. Evaluation for epilepsy surgery is performed in two or three phases. The first phase is hospitalization to locate the site of seizure origin by standard simultaneous video/EEG monitoring. A second phase may be necessary to further locate the site of seizure origin by invasive methods. The third phase is hospitalization for surgery to remove the site of seizure origin.

Vagus nerve stimulation: The VNS consists of an electrical wire and a generator. The wire is implanted in the neck and is connected to the vagus nerve at one end. The other end is connected to a generator that is implanted under the skin over the chest. The VNS works in two way: it is set to deliver an electrical charge to the vagus nerve at specific intervals and the patient can activate it if they feel the onset of a seizure. This device is also called a NeuroCybernetic Prosthesis (NCP).

Ketogenic diet: The Ketogenic Diet is designed to establish and maintain ketosis. The term, ketosis, refers to the excessive formation of ketones in the blood. Glucose, a carbohydrate, is the brain's preferred energy source. However, when the supply of carbohydrate is limited, the body produces ketones by burning fat tissue for energy. The brain then uses these ketones for energy. A similar accumulation of ketones occurs when a patient consumes very large amounts of fat and very small amounts of carbohydrate and protein. This accumulation of ketones in the blood tends to inhibit seizures.

Experimental drugs: These medications may be offered to appropriate patients who want to participate in clinical trials.