For some children with epilepsy, surgery may be the best option to prevent injury and improve their quality of life. The expert team in the Epilepsy Surgery Clinic at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, provides evaluation, treatment planning and care for these patients.

When Is Epilepsy Surgery Needed?

Candidates for epilepsy surgery are children for whom seizures are negatively impacting their day-to-day activities, reducing their quality of life and putting them at increased risk of injury.

Medication is the first line of treatment for patients with epilepsy. There are several medications that may be used to manage epilepsy. Surgery should be considered when two or more medications fail to adequately manage the child’s symptoms, or if an MRI shows abnormal results.

Why Choose Johns Hopkins All Children’s

Your child will receive care from a multidisciplinary team of experts that includes neurosurgeons, neurologists, neuropsychologists, neuroradiologists, therapists, neurodiagnostic technicians, advanced practice providers, nurses and a social worker.

Led by Matthew Smyth, M.D., who specializes in epilepsy surgery and is chief of the hospital’s pediatric neurosurgery division, the team has the expertise to appropriately evaluate your child’s condition and develop a treatment plan. The multidisciplinary team works together to provide expert evaluation for your child and will meet with your family as a team to discuss the best course of treatment for your child.

Evaluation and Treatment

Children who may be candidates for epilepsy surgery will receive thorough evaluation from our team to determine the course of treatment that will best meet their individual needs. Evaluation can include:

• EEG (electroencephalogram), which uses small metal discs attached to the scalp to measure the brain’s electrical activity.
• High-resolution MRI to evaluate any structural abnormalities or lesions in the brain that may be causing your child’s seizures.
• Genetic, metabolic and autoimmune testing
• PET (positron emission tomography) scan to observe metabolic activity of the brain and possible seizure onset zones.
• Ictal and interictal SPECT (single-photon emission computerized tomography) scan, which can help to identify the area in the brain where seizures originate.
• Functional MRI to evaluate the eloquent cortex (the part of the brain responsible for language, motor and sensory functions)
• MEG (magnetoencephalogram) to measure the magnetic fields produced by electrical activity within the brain.
• Neuropsychology evaluation to determine any issues with problem solving, reading, visual identification, naming, language function, memory or movement. Areas where patients have issues with these are usually the area(s) in the brain where seizures are occurring.
• Psychiatric evaluation to assess the patient’s emotional readiness for surgery and family support.
• Evaluation of patients’ visual fields

Sometimes additional evaluation is needed. This may include:

• Video EEG monitoring to further identify the location of seizure onset in the brain.
• Brain mapping with MRI imaging to evaluate cognitive functions such as controlling language, movement or vision.
• Cortical stimulation mapping to identify areas of the brain that control sensory, motor or language function.

The multidisciplinary team will meet to discuss the results of your child’s evaluation. The team will then meet with you and your child and family to discuss next steps, including which surgical option is best for your child.

The goal of surgery is often to “cure” a patient’s epilepsy, but often the goal is to improve their quality of life and prevent the risk of injury related to seizures. Our team will work with you to make sure you fully understand your child’s options and what you can expect from surgery.

Follow-up Care

After your child is discharged following their surgery and recovery in the hospital, they will typically continue to take medication and will be seen by the clinic team every three to six months to monitor their condition.