Complications and Consequences of Epilepsy Surgery, Ketogenic Diet, and Vagus Nerve Stimulation

Children with medically intractable epilepsy may be candidates for nonpharmacologic therapies such as resective and disconnection epilepsy surgery, the ketogenic diet and its variants, and vagus nerve stimulation. Each of these therapies offers unique advantages and disadvantages, and careful consideration of the risk-benefit analysis must be tailored to each child. The hopeful outcome from each of these therapies is seizure freedom or at least a very significant improvement in seizure control, with few or no adverse effects. However, unfortunate adverse consequences can and do occur. These may be serious and irreversible or more commonly mild and transient. An appreciation of these complications and consequences is necessary for the comprehensive management of these complex patients.