Don't wait too long to consider epilepsy surgery for young children, a new study indicates.
Kids who suffer frequent epilepsy seizures don't develop normally. Most have retarded mental and social development.
Seizure control -- with epilepsy drugs or a special diet -- lets children resume normal development. But for some of these kids, drug and diet treatments don't work. A drastic, but often effective option is epilepsy surgery. This surgery removes or disables a well-defined part of the brain responsible for seizures.
In about nine out of 10 cases, surgery reduces seizures. About two out of three surgery patients become seizure-free. But parents worry that brain surgery will harm young children's future development.
Just the opposite is true, suggest Hedwig Freitag, MD, and Ingrid Tuxhorn, MD, of the Bethel Epilepsy Center in Bielefeld, Germany. They studied 50 preschool children -- 40 of them for two to 10 years -- after epilepsy surgery. They found that early surgical treatment prevents further seizure damage and lets kids resume mental and social development.
"[There appears to be] a window of vulnerability for irreversible decline of cognitive potential," Freitag and Tuxhorn write in the April issue of Epilepsia. "Early surgical control of seizures may therefore have a marked impact on the developmental potential of children with early onset, severe epilepsy."
It's good news, says neurologist Gregory L. Barkley, MD, chairman of the Epilepsy Foundation advisory board and vice president of the National Association of Epilepsy Centers. Barkley is also clinical vice chairman of neurology at Henry Ford hospital and an associate professor at Wayne State University.
"This is very reassuring for parents that epilepsy surgery can help children catch up with their peers," Barkley tells WebMD.
Epilepsy Surgery: A Serious Solution for a Serious Problem
Most children with epilepsy don't need surgery, says epilepsy specialist Sandra Helmers, MD, associate professor of neurology at Emory University School of Medicine in Atlanta. Those who might benefit from surgery have very serious, very frequent seizures.
"These are not typical patients," Helmers tells WebMD. "There are kids in this study that had up to 20 seizures a day. These are all kids who do not respond to medication. What do these kinds of seizures do to a child's brain? How does it interfere with developmental milestones? A number of these kids were retarded, and that is not unusual for such children. And these frequent seizures have an enormous impact not just on these kids but on their families."
The first thing to try is medication, Barkley and Helmers say.
"When you have uncontrolled seizures, with every additional drug there is chance of being seizure-free," Barkley says. "That's a good reason to try drugs you haven't tried before. But after a reasonable trial of a few drugs, it is time to think seriously about surgery. And in kids it is even more urgent. Because if you do it today rather than wait two or three years, you keep your child from falling farther behind."
Barkley recommends that parents make the decision whether or not to have surgery within two or three years of epilepsy onset.
Even then, not every child should have surgery. It's necessary to pinpoint the affected area of the brain and to make sure that this area of the brain does not control crucial mental or physical functions.
"The evaluation is quite extensive, so we know not only how to take out that section of brain but how to leave that portion of the brain that is important for language, memory, and so on," Helmers says.
The long-term results, Freitag and Tuxhorn report, can be impressive. After surgery, four out of five kids in their study resumed mental and social development. Nearly three-fourths of the kids continued to improve. This occurred even in kids who were retarded prior to surgery. One out of five kids gained at least 15 IQ points after surgery.
"There is a lot to lose in kids who continue to have seizures," Helmers says. "This study shows we should think of epilepsy surgery sooner rather than later because of improved outcome in these children."
Both Helmers and Barkley warn that epilepsy surgery is a complicated procedure. They recommend that parents considering surgery consult a qualified epilepsy center.
SOURCES: Freitag, H. and Tuxhorn, I. Epilepsia, April 2005; vol 46: pp 561-567. Gregory L. Barkley, MD, chairman, Epilepsy Foundation professional advisory board; vice president, National Association of Epilepsy Centers; clinical vice chairman, neurology, Henry Ford Hospital; and associate professor, Wayne State University, Detroit. Sandra Helmers, MD, associate professor, neurology; director, EEG laboratory, Emory University School of Medicine, Atlanta.