Surgery

Ask your doctor to call (608) 890-6500 to refer your child to UW Health's Pediatric Epilepsy program.

If the seizures come from one focus area and that focus is in a part of the brain not performing essential activities (such as those areas controlling language or motor functions), then surgery may be your child's best chance to be seizure-free. Patients can be seizure free in 40-90 percent of cases (depending on details of the case) which is 10 times better than any other form of therapy.

 

Before your child goes to surgery, the surgeon needs to know exactly where to operate, so we do intensive monitoring in advance of surgery.

 

How Surgery May Help

 

Meet children who have had surgical treatment for epilepsy:

 

Read Sadie's story

Read Kaden's story

Read Milena's story

At American Family Children's Hospital, our team provides the most sophisticated level of surgical options for children with epilepsy in a state-of-the art facility.

 

Comprehensive Epilepsy Presurgical Evaluation (CEPE)

 

Your child will first be seen by one of pediatric epileptologists. He or she will then help you select the best form of therapy. If your child might be a good candidate for epilepsy surgery, your pediatric epileptologist will select from a variety of advanced diagnostic procedures to determine if surgery may indeed be a good option for your child.

 

Advanced diagnostic procedures can be time-consuming to schedule and perform. Our Comprehensive Epilepsy Presurgical Evaluation (CEPE) program was designed to reduce the impact on your child and family by coordinating many of the required testing and evaluation in one admission that will be completed within 5 to 11 days: 

  • Pre-surgical evaluation is a combination of inpatient and outpatient care.

  • The total amount of time needed will be as little as 5 days and as long as 11 days.

  • Your child will be evaluated on Days 1 and 2 as an outpatient and then admitted for observation in the Epilepsy Monitoring Unit on Day 3 (usually a Friday).

  • Outpatient testing include in-depth neuropsychological evaluation and advanced imaging potentially including a PET scan, MRI, DTI and functional MRI. The exact studies that are needed will be determined by your child's epileptologist.

  • On Day 3, your child will be admitted to the Epilepsy Monitoring Unit (EMU) and hooked up to video-EEG. We then attempt to capture seizures on video-EEG for further analysis.

  • Your child's medications may be tapered down or even off in order to capture enough seizures for analysis.

  • The EMU is staffed by specially trained nurses, nurse practitioners and physicians to keep your child safe.

  • On Days 5-11, we may try to capture a seizure followed by immediate intravenous injection of a radioisotope that follows the course of blood flow in the brain. If successful, your child will then be taken for a specialized brain scan called a SPECT scan where the seizure focus will show up as a "hot spot." This kind of scan is difficult to perform. We will have one 4-hour window each day on Days 5-11 to attempt to capture a seizure in this way.

  • After your child is done, we will restart his or her home medications, make sure that he or she is safe to go home, and then discharge home when safe to do so.

  • Patients and families are provided with housing at the Ronald McDonald House for free (if available) or at the Best Western InnTowner for a discounted price. There is a free shuttle from the Best Western InnTowner to the hospital. After the child is admitted to the EMU, one parent can stay in the hospital with the child for the duration of the study.

  • Your doctors will analyze all the data accumulated during CEPE and then discuss with you further options. These further options may include going directly to surgery, or your child may require more invasive studies, such as intracranial EEG (where EEG electrodes are placed right on top of the brain itself or carefully inserted into the brain).

 

ROSA (Robotic Stereotactic Assistance)

 

When intracranial EEG studies are required, options include a traditional grid approach whereby a grid of EEG electrodes is placed directly on top of the brain. To do this, it is necessary to open a portion of the skull (called a craniotomy).

 

A less invasive procedure is that of stereo-EEG, whereby a thin electrode is inserted into the brain in a targeted way. The surgeon in this case first drills a very small hole in the skull (the thickness of a pencil lead), through which the electrode is then inserted. Stereo-EEG is well-tolerated by most patients and causes much less discomfort and much faster recovery than a grid study with craniotomy.

 

To help with the insertion process of stereo-EEG, we now have the help of ROSA Robot. ROSA can help map out and execute the safest trajectory for the electrodes and is especially helpful when the source of seizures is deep in the brain.

 

Vagus Nerve Stimulation

 

Vagus nerve stimulation (VNS) can be helpful for children over 12 who have been diagnosed with focal (partial) epilepsy and whose seizures are difficult to manage with medication.

 

While VNS doesn't cure epilepsy, it can improve your child's quality of life by helping to reduce the number of seizures your child has and how long they last. About one-half of patients reduce their seizures by half or more, and one-third experience no change.

 

With vagus nerve stimulation, surgeons implant a device that is similar to a pacemaker under the skin. The device sends a mild, electrical signal to the vagus nerve in the neck, which then sends a signal back up into the brain, providing a mild stimulation of the brain. The electrical signal helps reduce the number of seizures from which epilepsy patients suffer.

 

More About Vagus Nerve Stimulation

  • The VNS device is initially set to deliver the electrical signal for about 30 seconds every five minutes but is adjusted according to the patient's needs. 
  • Patients are given a magnet that allows them to give an extra "dose" of electrical stimulation. In some patients, this extra dose can stop an ongoing seizure. 
  • The surgery is relatively minor, takes about two hours and does not directly involve the brain. Your child will be admitted overnight for observation. 
  • Risks include infection and bleeding (1 to 2 percent) and damage to the nerve supplying the muscles in the voice box (less than 1 percent). 
  • Side effects include tingling in the neck while the stimulator is on, changes to the voice including hoarseness, coughing and changes in swallowing and shortness of breath.