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Published on: May 11, 2018
Intracranial stimulation for children with epilepsy
Antonio Valentín1, Richard P Selway2, Meriem Amarouche2
1Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK.
Insights
Intracranial stimulation, including subacute cortical stimulation (SCS) and deep brain stimulation (DBS), shows promise for treating refractory epilepsy in children. Most patients experienced significant seizure reduction with well-tolerated procedures.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Refractory epilepsy in children poses significant treatment challenges.
- Intracranial electrical stimulation is an emerging therapeutic option.
Purpose of the Study:
- To assess the efficacy and tolerability of intracranial stimulation for pediatric refractory epilepsy.
- To evaluate both subacute cortical stimulation (SCS) and deep brain stimulation (DBS).
Main Methods:
- Retrospective analysis of 8 children with refractory epilepsy undergoing intracranial stimulation (2014-2015).
- Five children received SCS; three received DBS (centromedian or anterior nucleus).
- Efficacy measured by seizure frequency, severity, and interictal discharge reduction.
Main Results:
- Four of five children (80%) with SCS showed >50% seizure reduction.
- Two of three children (67%) with DBS experienced >60% improvement in seizures.
- Procedures were well-tolerated in all pediatric participants.
Conclusions:
- Cortical and thalamic stimulation are effective and safe for pediatric refractory epilepsy.
- SCS aids in identifying seizure foci and predicting surgical outcomes.
- Larger studies are warranted to confirm these findings.
Objectives:
To evaluate the efficacy of intracranial stimulation to treat refractory epilepsy in children.
Methods:
This is a retrospective analysis of a pilot study on all 8 children who had intracranial electrical stimulation for the investigation and treatment of refractory epilepsy at King's College Hospital between 2014 and 2015. Five children (one with temporal lobe epilepsy and four with frontal lobe epilepsy) had subacute cortical stimulation (SCS) for a period of 20-161 h during intracranial video-telemetry. Efficacy of stimulation was evaluated by counting interictal discharges and seizures. Two children had thalamic deep brain stimulation (DBS) of the centromedian nucleus (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy), and one child on the anterior nucleus (right fronto-temporal epilepsy). The incidence of interictal discharges was evaluated visually and quantified automatically.
Results:
Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children with SCS, four showed improvement in seizure frequency (>50%) and one chid did not show improvement. Procedures were well tolerated by children.
Conclusion:
Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary.
