What is the primary treatment modality for children with epilepsy who do not respond to medication?

For children with epilepsy who do not respond to medication, the primary treatment modality is surgical intervention. This approach is typically considered when a child experiences persistent seizures despite trying multiple appropriate anti-epileptic drugs. Surgery can be particularly effective when the seizures are localized to a specific area of the brain that can be safely removed.

Surgical options may include resective surgery, where the area of the brain responsible for seizures is surgically excised, or techniques like corpus callosotomy or hemispherectomy in more severe cases. The decision for surgery usually involves a comprehensive evaluation, including video EEG monitoring and neuroimaging studies to accurately identify the seizure focus.

The other treatment options, such as medication adjustment, are usually the first line of treatment for epilepsy, but in cases where those adjustments fail, surgical intervention becomes a critical next step. Physical therapy and cognitive behavioral therapy may provide supportive care, but they do not directly address the underlying neurological condition that causes the seizures. Instead, they may be used to help manage associated issues like behavioral problems or developmental delays.