Treatment Options

A wide range of medical options is available for managing seizures in children. If the cause is known, it may be possible to eliminate the seizures entirely by treating the cause. Several syndromes are typically of short duration and they, too, will end without the need for seizure therapy. Most syndromes will require some form of seizure treatment, however, at least until the seizures go into final remission.

Medication is the first line of therapy for seizures. Although an extensive array of seizure medications is available overall, the choice for treating particular syndromes is limited. Hormonal therapy— the use of adrenocorticoropic hormone (ACTH) and prednisone (a synthetic corticosteroid drug)— is also beneficial in some cases.

Each child responds differently to medical therapy. Thus, children who experience the same syndrome may differ in the drug or form of therapy that works best for them.

Dose effectiveness in children is less predictable than in adults. This is because the rate at which children metabolize drugs can vary dramatically with age, especially in the first year of life. Illness with high fever is more common among children than adults, a factor that can also affect drug metabolism. Children whose syndromes are severe may require multiple drugs leading to drug interactions. Simultaneous treatment for another illness can also increase the potential for drug interactions.

A stringent medically supervised diet, the ketogenic diet, may be prescribed for children with certain severe epilepsy syndromes when medications fail. Like all medical therapies, the diet can have significant side effects. Brain surgery in selected cases may also be an option when medications fail and there is little risk of damage to vital brain tissue and function. Vagus nerve stimulation (VNS) using an implantable device is more commonly used in adults, but may have benefit in a small number of selected children with intractable seizures.