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Children with epilepsy

Approximately 1 percent of all children in Germany suffer from epilepsy. For children, as well as for adults, various treatment strategies are used. The main aim of the treatment is the cease of the epileptic seizures. Depending on the form of epilepsy, the severity of seizures and other neurological and psychological disorders the individual concepts of therapy are worked out. Then the doctors decide whether the treatment is appropriate or some changes should be made.

The treatment of epilepsy can be divided into 4 categories:

The main aim of the drug therapy is to protect the patient from the seizures to the greatest possible extent and, if it is possible, to avoid side effects, especially those which can damage the psychomotor development of a child. Depending on the form of epilepsy and the type of seizures the appropriate anticonvulsive drug (=medication which prevents the seizures) is prescribed during the ambulatory consultation.  The choice of the medication also depends on the individual aspect of the disease. In the majority of cases the children, in fact, dispose of the seizures during the appropriate long-term anticonvulsive drug therapy. After second and before the end of the third year of treatment the gradual reduction of the drug dose is made; and within a short period of time after that the administration of the medication is completely ceased. After such therapy only one third of children lapse into illness again. In case if the first drug is insufficiently effective or is badly tolerated, nowadays many other medications or combination drugs are available.

Ketogenic diet

In case of ineffectiveness or intolerance of the anticonvulsive drugs the ketogenic diet represents one more variant of therapy. During such diet the low carbohydrate and high fat products should be consumed. The hyperoxemia as a result of such diet will decrease the convulsive readiness as long as such diet is strictly kept. In order to provide the effectiveness and the stability of ketogenic diet the detailed pediatric and dietary consultation should be made before and during the diet. The result of the ketogenic diet depends on the motivation of the family to a great extent. The family, in turn, should be rendered assistance by child neurologists and diet-consultants within the framework of ambulatory treatment.

Within recent years the surgical treatment of epilepsy has become rather significant. Nowadays it is considered to be a safe and effective method of epilepsy treatment in case if the disease cannot be healed medicamentally. The prerequisite of the surgical treatment is a localized area in brain which is the reason of epilepsy development and the surgical removal of which will not lead to any substantial adverse effects. The Neurocenter of the Medical Center – University of Freiburg has made a significant contribution to the development and implementation of neurosurgical methods of epilepsy treatment. The special method of surgical epilepsy treatment is a surgical removal of the brain area which provokes the epileptic seizures. The localization of epilepsy focus and further surgical removal of this epileptogenic zone is a challenge for the highly-qualified team of doctors, especially if the patient is a child. The interdisciplinary collaborative work of child neurologists, neuroradiologists, neuropsychologists and neurosurgeons provides the brilliant results of epilepsy therapy among children as well as among adults.

According to the actual results of the scientific research the implementation of the vagus nerve stimulation (VNS) can in some cases have the positive effect on the frequency and severity of epileptic seizures. Vagus nerve stimulation is a battery-powered instrument as pulse transducer which is to some extent similar to the electric cardiostimulator (ECS). It is implanted under the skin in the upper left part of the breast and by means of the electrode is fixed on the vagus nerve on the neck. The batteries should be changed in 3-5 years. 

On the basis of the published data it is possible to make the conclusion that the frequency of epileptic seizures in case of the vagus nerve stimulation implementation is decreased in half almost in 50% of cases. First and foremost this method is appropriate if we deal with the focal epilepsy which is resistant to the drug therapy and in case if the operative intervention is inadvisable or undesirable. However, it is necessary to mention that in the majority of cases the complete cease of epileptic seizures is impossible.

The delays and violations of mental development can emerge in case of a stormy clinical course of epilepsy. Moreover, if the children with normal brain development have incompletely controlled seizures it is necessary to carry out the consultations with them and to take all applicable measures in order to find a place for them in kindergartens, schools or vocational institutions. In these cases the treatment of epilepsy includes not only drug and neurosurgical therapy but also competent social and pediatric support with the cooperation of doctors, teaching staff, psychologists and community workers. 

Medical Center - University of Freiburg

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