In 2010, Texas Children’s Hospital changed the landscape of surgical epilepsy care by introducing minimally invasive laser ablation therapy. Using real-time MRI-guided thermal imaging and laser technology, this procedure allows for precision treatment delivered to the exact area of the brain that causes a child’s seizures without the risks of an open brain surgery
Innovation continues to be a driving force at Texas Children’s Epilepsy Surgery Program. We’re improving the lives of children with seizures by expanding the uses for laser ablation procedures, clarifying diagnoses through invasive seizure monitoring and investigating genetic causes and treatments for seizures.
We offer children and families state-of-the-art surgical options to treat seizures that do not respond to medications. Our coordinated team will help guide you through the process.
Surgical options
Surgical options for epilepsy can be curative, meaning that the goal is to stop seizure activity, or palliative, meaning that the goal is to decrease the severity or frequency of the seizures.
Examples of curative procedures performed at Texas Children’s
Awake craniotomy is performed when the general sedation normally used during surgery will interfere with the procedure. Sometimes a child must be partially awake to monitor reflexes and reactions during surgery near sensitive areas of the brain.
Focal cortical resection removes damaged brain tissue that is causing seizures
Minimally invasive laser ablation surgery uses real-time MRI guidance and ultra-precise lasers to destroy a very specific location in the brain that is causing seizures.
Temporal lobectomy is a procedure that removes one of the temporal lobes when it is causing seizures that have not responded to several other therapies.
Examples of palliative procedures performed at Texas Children’s
Neurostimulation therapies involve implanting a device in the brain that dampens the seizure-causing electrical impulse that originates from a specific brain location.
Stereotactic radiosurgery uses multiple highly sophisticated radiation beams to destroy epilepsy-causing lesions in the brain.
Corpus callosotomy severs portions of the corpus callosum, the network of nerves that connects the two hemispheres of the brain, when this area is causing generalized seizures.
Multiple subpial transection is a technique used to destroy an area of the brain that causes seizures while protecting brain fibers that perform critical functions.
What to expect during invasive seizure monitoring
While many electroencephalograms (EEGs) are performed in clinics, more information can be obtained with invasive seizure monitoring. Invasive seizure monitoring works by placing electrodes in specific locations of the brain that will collect ongoing data about your child’s seizures. The electrodes are placed in the brain in the operating room and your child will be hospitalized for about 2 weeks following the procedure so that data about his or her seizures can be collected.
The goal of invasive seizure monitoring is to determine the exact location in the brain that is causing your child’s seizures. Once the exact location, or locations, are known, our neurosurgeons and epileptologists will be able to recommend an appropriate treatment plan. This information is especially important when considering surgery to treat your child’s seizures.
You can reach out to our Epilepsy Surgery Nurse Coordinator for more information about your child’s stay: 832-822-1100
Types of invasive seizure monitoring
Stereoelectroencephalography (SEEG)
Small wires called intracranial electrodes are placed into brain tissue. A neurosurgeon drills small holes into the skull to implant the electrodes. An advanced robot helps guide and assist the surgeon to carefully place each electrode. These electrodes are partially visible after the surgery and your child’s head is wrapped to protect them.
Intracranial grid placement
The skull is opened (craniotomy) to place a grid with electrodes directly onto the outer layer (cortex) of the brain. After surgery, your child has a head wrap in place with both electrodes and a drain coming from under the scalp.
About your child’s hospital stay for invasive seizure monitoring
After the procedure to place the seizure monitoring devices in your child’s brain, he or she will stay in the hospital in our specialized Epilepsy Monitoring Unit (EMU) for about 2 weeks so that our team of seizure experts can collect the information about his or her specific seizures that will help us know how best to guide treatment.
Some pain associated with the seizure monitoring devices is expected. Our team of nurses who are specially trained in epilepsy care will treat pain with oral and IV medications as needed. IV antibiotics are also administered to prevent brain infections. Ketogenic diets can be accommodated in the EMU.
Bedrest is essential
Your child will not be able to get out of bed to walk during their EMU stay. We know this is hard for your child and definitely not any fun. This is for your child’s safety.
Our child life specialists are involved in helping you and your child feel at home during this stay. Art therapy, music therapy and optional visits from our therapy dogs are important parts of your child’s treatment during admission.
Toys and activities from home are encouraged to distract your child from the boredom of being in bed. We recommend that you remember to bring activities for yourself as well. This is a difficult time for parents and caregivers — remember to take walks and breaks throughout the day.
Staying in bed means that your child cannot freely walk to a bathroom. A Texas Children’s team member will help your child use a bedpan when needed. In some cases, older children may be able to use a portable toilet or move to the bathroom with the assistance of a nurse.
Encouraging seizures
The epilepsy team observes and records your child’s seizures to get information on their location within your child’s brain. We may need to lower your child’s seizure threshold so that we can observe a seizure and pinpoint exact seizure locations. Our doctors and nurses are experienced at managing seizures and will have rescue medications ready to calm the seizures if needed. Slowly reducing seizure medication under the guidance of a neurologist and keeping your child awake for long periods without sleep are common ways to produce seizures. A nurse will be at the bedside at all times. Our EMU team is ready to support your child’s needs and you throughout this process.
Next steps
After the seizure activity is recorded, the Neurosurgery and Comprehensive Epilepsy Center teams hold a multidisciplinary meeting. As a group, they may recommend a surgical intervention for your child. In some cases, additional electrodes are needed to gather more information about your child’s seizures. The final surgery during this hospital stay will include removal of electrodes and may include any surgery or procedure recommended by your medical team.
Your child will stay in the hospital to complete the recovery process. In rare cases, additional invasive electrodes are required after the therapeutic operation for a short time. The team will let you know when your child is ready to return home.
Leaving the hospital
Your child will leave the hospital with the following items:
A school note with activity restrictions.
Wound care instructions – including how to wash the incisions 72 hours after surgery.
Any prescribed epilepsy medications. Some children are discharged home with antibiotics and steroids.
A follow-up clinic appointment to see how your child is healing after surgery.
Most children will have a clinic visit 2 weeks after discharge.
Out-of-state/international patients may be able to arrange an earlier visit at the discretion of your surgeon.
Activity restrictions:
Walking is the only physical activity allowed until your child is cleared by the team.
No running, jumping, biking, skateboarding, weightlifting, swimming or other sports until you have approval from your child’s medical team.
Returning to school and activity restrictions are decided on a case-by-case basis. Everyone recovers at their own pace.
