Epilepsy

Pediatric neurosurgery frequently encounters epilepsy, also known as seizure disorder. It is caused by abnormal electrical activity in the brain’s nerve cells. Epilepsy refers to the occurrence of recurrent seizures without an external triggering factor. During a seizure, the patient may experience head dropping forward or sideways, excessive salivation, involuntary movements of the arms, legs, or body, loss of consciousness, and urinary incontinence. It is most commonly seen in children during adolescence.

Symptoms

The most significant symptom of epilepsy is the seizures experienced by the patient.

Diagnosis

The most common diagnostic tool for epilepsy is EEG. EEG allows doctors to observe the brain’s electrical activity. During the procedure, electrodes are placed on the scalp. For infants, the test is scheduled during their sleep time. The procedure lasts about one hour, during which brain activity is recorded. In some cases, MRI and CT imaging may also be used to support the diagnosis of epilepsy.

Causes

Epilepsy may have many different causes, such as infections during pregnancy, oxygen deprivation during childbirth, developmental brain malformations, and genetic predisposition.

Treatment

There are two main treatment options for epilepsy: medication and surgery. The first-line treatment is medication. Based on EEG findings, the appropriate drug is selected according to the type of epilepsy, and treatment begins. If medication does not provide results, surgical treatment may be considered. Before surgery is evaluated, patients are usually treated with different anti-epileptic drugs for about two years, though this period may be shorter in children. In most cases where epilepsy surgery is required, an anomaly is visible on MRI scans. The surgical procedures that can be applied in such patients include:

• Focal resection: Removal of the epileptic region
• Corpus callosotomy: Severing the connection between the two halves of the brain
• Hemispherotomy: Disconnecting the affected hemisphere from the healthy side if one hemisphere is severely damaged
• Vagus nerve stimulation: Implanting a device to stimulate the vagus nerve and reduce seizures