Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving...

Area of Science:

• Neurology
• Neurosurgery

Background:

• Pediatric refractory epilepsy (PRE) often requires neuromodulation when surgical resection is not feasible due to multifocal onset or eloquent cortex involvement.
• The landscape of neurostimulation therapies for PRE is rapidly evolving.

Purpose of the Study:

• To describe institutional experience with various neurostimulation therapies for PRE.
• To evaluate the safety and efficacy of deep brain stimulation of the anterior nucleus (DBS-ANT), deep brain stimulation of the centromedian nucleus (DBS-CM), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS).

Main Methods:

• Retrospective chart review of pediatric patients (≤18 years) with PRE.
• Inclusion criteria: at least 1 year of follow-up post-neurostimulation initiation.
• Responders defined as ≥50% seizure frequency reduction.

Main Results:

• 35 patients included: 9 DBS-ANT, 9 DBS-CM, 5 RNS, 12 CSS.
• 59% of patients (23/35) were responders, with seizure reduction rates of 25% (DBS-ANT), 89% (DBS-CM), 87% (RNS), and 88% (CSS).
• Low complication rate (9%) with no permanent deficits; 17% reported improved neurocognitive outcomes.

Conclusions:

• Deep brain stimulation (DBS), RNS, and CSS are safe and effective neuromodulation options for PRE.
• Tailoring therapy to individual patients can optimize treatment outcomes.
• Neuromodulation offers a viable alternative for managing difficult-to-treat pediatric epilepsy.