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Updated: Jul 7, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Safety & feasibility of responsive neurostimulation in children with refractory epilepsy: A single-center experience
Stephanie Enner1, Maria El-Hallal1, Katherine Hogan1
1Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, 2001 Marcus Avenue Suite W290, Lake Success, NY 11042, United States.
Insights
Responsive neurostimulation (RNS) is safe and feasible for children with refractory epilepsy. This epilepsy surgery option showed no worsening seizure frequency and a significant reduction in long episodes for some patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epilepsy Management
Background:
- Responsive neurostimulation (RNS) is FDA-approved for adult intractable focal epilepsy.
- Limited data exists on RNS use in patients under 18 years old.
Purpose of the Study:
- To evaluate the safety and feasibility of RNS in children with refractory epilepsy.
Main Methods:
- Retrospective chart review of pediatric patients undergoing RNS implantation.
- Data collected included demographics, seizure onset, RNS targets, and post-operative outcomes.
Main Results:
- One of 14 patients experienced a surgical site infection requiring explantation.
- Post-operative imaging was negative for complications in 13/14 patients.
- No patients reported increased seizure frequency at 6-month follow-up; a subset showed significant reduction in long episodes.
Conclusions:
- RNS is a safe and feasible epilepsy surgery option for children aged six and older with refractory epilepsy.
- Accurate seizure focus identification is crucial for successful RNS implantation.
- RNS can be used with other surgical modalities and accommodates broad or multifocal epileptogenic networks.
Objectives:
Responsive neurostimulation (RNS) is a relatively recent addition to the epilepsy surgery armory, gaining FDA approval in 2013 for use in adults with intractable focal epilepsy. Data for the use of RNS system in patients less than 18 years of age is limited. We aim to determine the safety and feasibility of RNS in children with refractory epilepsy.
Methods:
A retrospective chart review was conducted for all patients who underwent RNS implantation at an urban tertiary children's hospital. Demographics of the patients were obtained, including age at the time of implant, MRI findings, seizure onset zone identification, and RNS targets.
Results:
Out of a fourteen patient cohort, one patient had a post-operative complication of infection at surgical site requiring explantation. Thirteen out of 14 patients had immediate post-operative head imaging that was negative for hemorrhage, infarction, or skull fracture; one patient did not undergo head imaging. No patients reported a worsening clinical seizure frequency at a 6-month follow up visit. In the subset of patients who were implanted with RNS and did not undergo concurrent resections, there was a statistically significant reduction in the average number of long episodes at the most recent visit when compared to the 1-month post-operative visit (p = 0.0268).
Conclusions:
RNS is a feasible and safe option for children as young as six years with refractory epilepsy when appropriate seizure focus identification has been performed with stereo CT and stereo EEG evaluations, and can be used in conjunction with other surgical epilepsy treatment modalities. Two canister RNS placement is achievable for patients with a broad epileptogenic network or multifocal seizure onset zones.
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