A seizure treatment plan that works best for your child’s needs may involve multiple therapies.
If your child is having seizures, a treatment plan will start with medication to help prevent episodes from occurring. But if medication isn’t enough, sometimes dietary changes are also recommended. The right seizure treatment plan for your child will depend on a host of factors, including some caregiver preferences.
“I like to involve the family in the decision-making,” said Dr. Shilpa Reddy, a pediatric epileptologist at Monroe Carell Junior Children’s Hospital at Vanderbilt. “This is a team effort.”
Seizure medications for kids
First, your pediatric neurologist will confirm whether seizures are occurring and, if so, what kind. A certain pediatric seizure medication may work best for the specific epilepsy syndrome and/or seizure type your child has. “We also tend to choose medications that have favorable side-effect profiles for the patient,” Reddy said. Side effects may vary based on age, gender, what other medications they are on, and what side effects they have experienced with prior medications.
In some cases, medication may not be enough to control seizures. “If we’ve tried two medications at the maximum doses,” Reddy explained, “and we’re not seeing an improvement, then I will bring up the next options.” One possibility includes adding another prescription.
“But once you are trying a third medication,” she added, “you have a less than 5% chance that this medication is going to resolve your seizures.” Plus, additional medications come with potential side effects, such as excessive sleepiness.
Reddy said she also discusses with families whether their child is a candidate for epilepsy surgery, especially if a procedure would present a cure. But she also outlines potential dietary changes as a next line of pediatric seizure treatment.
How diet changes help prevent seizures
Modifying your child’s diet may also help control seizures. “The thought behind all of the diet therapies,” Reddy explained, “is that by limiting the amount of carbohydrates that are being used as fuel by your brain and increasing the fat that is used as fuel by your brain makes the seizures less likely to occur.” With dietary changes, she said, about half of kids see a 50% reduction in their seizures. However, studies show that a majority of families report an improvement in their child’s quality of life after starting the anti-seizure diet.
Dietary therapies for seizures in children
“One thing that applies to diet therapy and the management of epilepsy is balancing quality of life and seizure control. So whatever option we choose, we want to keep that in mind.”
When it comes to controlling seizures with diet changes, parents usually have three options: the ketogenic diet, the modified Atkins diet or the low glycemic index diet. The diet that might be right for your child will depend on different factors. “One thing that applies to diet therapy and the management of epilepsy,” Reddy said, ”is balancing quality of life and seizure control. So whatever option we choose, we want to keep that in mind.”
The ketogenic diet for seizures involves a precise measurement of carbohydrates, fats and protein, with carbohydrates being the most limited. But because it requires such precision, Reddy said this option is often a better fit for families with kids who are tube fed.
“If kids are eating by mouth,” she explained, “it’s often a significant lifestyle change for the whole family.” Parents either create a separate meal plan and snacks for one child, or the whole family adopts the same strict diet. But for kids who are tube fed, the ketogenic diet is a logistically easier transition, as they are given a different type and way to mix formula.
The modified Atkins diet also involves counting carbohydrates, but Reddy said it’s a little easier to manage for kids who are eating by mouth. And finally, the low glycemic index diet is the least restrictive option. Rather than requiring the counting of carbohydrates, the diet involves choosing carbs that have a low glycemic index.
“I tend to share my entire thought process with families from the beginning,” Reddy added, “because I want them to feel empowered in their child’s epilepsy journey.”
Monroe Carell Jr. Children’s Hospital at Vanderbilt brings together multiple experts in pediatric neurology, pediatric neurosurgery, pediatric neuroradiology, psychologists, dieticians, pharmacists and nurses, all working to care for patients not just as those with epilepsy but as whole children. The Comprehensive Epilepsy Clinic offers expertise in difficult-to-treat seizures and comprehensive epilepsy management, including medications, diet and surgical options tailored to each child.