Epilepsy in Children

Epilepsy in Children

Diagnosing and Treating Seizures in Your Child

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Diagnostic and treatment advances have made it possible for most children with epilepsy to live controlled, seizure-free lives. At Duke, that's our pediatric epilepsy specialists’ primary goal. From dietary changes and new neurostimulators to high-tech MRI-guided laser ablation surgery, we have the expertise and resources to treat your child’s seizure disorder quickly and effectively.

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Diagnosing Epilepsy and Seizure Disorders in Infants and Children

A comprehensive evaluation is the first step, whether your child has experienced his or her first seizure, or suffers from chronic seizures. Seizures may have many different causes, including genetics, abnormal structure of part of the brain, autoimmune disease, infection, tumors, and bleeding.

Sophisticated imaging and brain-activity monitoring can help us diagnose the cause of your child's seizures and their origin in the brain. Electroencephalography can help confirm the diagnosis, determine the seizure type, and guide therapy decisions. Genetic tests may be performed if the epilepsy is drug-resistant or if you have a family history of seizure disorders. Neuropsychological testing helps us understand the relationship between the brain and the nervous system.

Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.

Medical Treatments

Anti-Seizure Medicines

These are the first line of defense for epilepsy. However, a drug that helps one child may not be effective for another. Our doctors determine which safe and effective drugs may be most appropriate for your child and then help you decide on the treatment plan. 

Special Diets

For some children, diet can be as effective as, or even more effective than, medication in controlling seizures. A nutritionist works closely with you to decide which of a number of dietary options may best suit your child, including the ketogenic, modified-Atkins, and low-glycemic diets. These are eating plans that have been effective in controlling seizures in many patients. They restrict carbohydrates and focus on high-fat, high-protein foods that may help the body generate and build up ketones, which can prevent seizures and can also have long-lasting beneficial effects.

Personalized Medicine

We are one of only a handful of centers to offer “precision medicine,” a new, personalized approach that combines the sciences of drugs and genetics to develop medications that specifically target your child’s individual chemistry.

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Surgical Procedures

Vagus Nerve Stimulation (VNS)

VNS therapy involves implanting a pacemaker-like device in the chest. It controls seizures by sending electrical impulses to the vagus nerve. This outpatient procedure is typically considered in children whose seizures cannot be controlled through medication. 

Responsive Neurostimulation (RNS)

In RNS, a device implanted under the scalp connects to electrodes placed long-term on the surface of the brain. The device identifies and then stops the abnormal electrical patterns in the brain that can lead to clinical seizures. This device is FDA-approved for those ages 18 years and older and is used in patients for whom focal resection is not a viable alternative. 

Laser Ablation Surgery

Neurosurgeons use MRI imaging to guide the insertion of a thin laser that destroys brain lesions responsible for epilepsy and uncontrolled seizures. Because the surgery requires small incisions, your child will recover faster than with open brain surgery.

Focal Cortical Resection

Removes the specific area of the brain causing the seizures. This procedure can often stop the seizures entirely and thus is the preferred procedure, whenever applicable, in patients who have not responded to medications. This procedure can provide seizure freedom in 60 percent to 80 percent of patients.

Corpus Callosotomy

When the specific origin of the seizure cannot be identified, this procedure removes a section of a band of tissue called the corpus callosum that sends messages across the brain. This prevents seizures from spreading from one side of your child’s brain to the other. It is usually performed in patients with drug-resistant seizures that cause falls and injuries.

Hemispherectomy

Recommended for children with very severe epilepsy caused by one hemisphere of the brain that is markedly malformed or injured. This procedure disconnects those parts of the brain that are causing the seizures and are not functioning as they should. It can resolve seizures in up to 80 percent of children.

Level 4 Epilepsy Center
As a Level 4 Epilepsy Center, Duke Health provides the highest level of diagnosis, medical and surgical treatments for people with epilepsy. It is one of the reasons why Duke Children’s is nationally ranked in pediatric neurology and pediatric neurosurgery by U.S. News & World Report for 2019-2020.

Helping Your Child Live Seizure-Free

Sophisticated Imaging Technology
We use the most sophisticated imaging technology, including advanced MRI, PET, and SPECT& to look for physical causes of seizures. Video EEG monitors brain activity and attempts to locate the origin of the seizure. The Wada test evaluates how language and memory are controlled on each side of the brain.

Epilepsy Monitoring Unit
If we need to monitor your child’s brain activity for 24 hours, your child can stay overnight in our eight-bed epilepsy monitoring unit. It is staffed by epilepsy experts who use technologically advanced equipment to identify the origin of your child’s seizure activity.

Pre-Surgical Brain-Mapping Technique
We are one of a handful of U.S. centers using a pre-surgical brain-mapping technique called SEEG. The robotic technology requires only a few small incisions and allows your child’s neurosurgeon to precisely place electrodes in the brain during a shortened procedure time. This results in your child feeling better faster.

Additional Testing
If an underlying cause for your child’s epilepsy is not identified, he or she may participate in additional advanced testing through the National Institutes of Health (NIH) Undiagnosed Disease Program. Duke is one of only 12 clinical sites nationwide participating in this program.

Expert Doctors
Your child’s doctors -- including neurologists who specialize in pediatric epilepsy, neurosurgeons, and neuropsychologists -- have held leadership positions in leading epilepsy organizations, including the American Epilepsy Society, International Child Neurology Association, American Board of Pediatrics, and World Health Organization.

Team-Care Approach
Our skilled pediatric epilepsy doctors work alongside other specialists, nurses, dietitians, pharmacists, and social workers. We work as a team to develop recommendations about your child’s care and treatment plan. Our nurse coordinator helps with scheduling appointments, making travel arrangements, and navigating hospital-related details.

Child-Friendly Staff
Our friendly nursing and other staff work with child life specialists to make your child’s time with us as pleasant as possible by providing age-appropriate entertainment and activities.

Access to New Therapies and Trials
We use the latest advances to care for the most complex, drug-resistant, difficult-to-control seizures. This includes the availability of new therapies through clinical trials, as well as programs to improve the effectiveness of surgical procedures and implantable neurostimulators that control seizures.

Care Transition as Your Child Grows
We provide the full range of care as your child develops from infant to adolescent and transitions to adulthood.

Effective Results
We reduce and/or eliminate seizures in children who are unable to find successful treatment elsewhere.