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Updated: Dec 9, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Responsive neurostimulation for refractory epilepsy in the pediatric population: A single-center experience
Marian Michael Bercu1, Daniel Friedman2, Alyson Silverberg3
1Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Health, New York, NY, United States of America; Division of Pediatric Neurosurgery, Pediatric Neurosciences Center, Helen DeVos Children's Hospital, Spectrum Health, Grand Rapids, MI, United States of America.
Insights
Responsive neurostimulation (RNS System) offers a safe and effective treatment for drug-resistant focal epilepsy in children, improving seizure control and quality of life when surgery is not an option.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Drug-resistant focal epilepsy (DRFE) in children significantly impacts cognition, behavior, and survival.
- While pediatric epilepsy surgery has advanced, many children are ineligible due to seizure networks near critical brain areas or multiple seizure origins.
- Responsive neurostimulation (RNS System) is an established therapy for adult DRFE, particularly when foci are in eloquent cortex.
Purpose of the Study:
- To evaluate the safety and efficacy of the RNS System in pediatric patients with DRFE.
- To assess the impact of RNS therapy on seizure frequency, functional status, and quality of life in children.
Main Methods:
- Retrospective case series of six pediatric patients with DRFE who underwent RNS System implantation.
- Analysis of clinical seizure frequency, semiology, functional status, and quality of life outcomes.
- Correlation of stimulation parameter adjustments with clinical changes.
Main Results:
- RNS System implantation was safe in pediatric patients.
- Demonstrated decreased clinical seizure frequency and improved functional status and quality of life.
- Observed correlation between stimulation parameter adjustments and changes in seizure semiology and frequency.
Conclusions:
- Responsive neuromodulation using the RNS System is a safe and effective therapeutic option for pediatric patients with drug-resistant focal epilepsy.
- The therapy shows promise in improving seizure control and overall well-being in pediatric populations where surgical resection is not feasible.
Abstract:
Drug-resistant focal epilepsy (DRFE) in children can impair cognition and behavior, and lead to premature death. Increased pediatric epilepsy surgery numbers reflect the improvements in seizure control and long-term developmental outcomes. Yet, many children with DRFE are not candidates for surgical resection due to overlap of the seizure network with eloquent cortex or multiple seizure-onset zones, making surgery dangerous or ineffective. In adults, responsive neurostimulation (RNS System) therapy is safe and effective treatment for DRFE with one or two seizure foci, especially when the seizure focus is in eloquent cortex. We present six pediatric patients with DRFE who underwent RNS implantation. Our outcomes demonstrate safety, decreased clinical seizure frequency, as well as improved functional status and quality of life. Changes in the clinical seizure semiology and frequency occurred in conjunction with adjustments to the stimulation parameters, supporting the efficacy of responsive neuromodulation in children.
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