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Responsive Neurostimulation of Thalamic and Nonthalamic Targets in Pediatric and Young Adult Patients With
Thomas Larrew1, Hansel M Greiner2, Ravindra Arya2
1Division of Pediatric Neurosurgery, Riley Hospital for Children at IU Health, Indianapolis , Indiana , USA.
Insights
Responsive neurostimulation (RNS) is a safe and effective treatment for reducing seizures in pediatric and young adult epilepsy patients when resection is not possible. Both thalamic and nonthalamic RNS lead placements show significant seizure reduction.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Epilepsy
Background:
- Epilepsy significantly impacts cognitive and psychosocial development in young patients.
- Responsive neurostimulation (RNS) offers a treatment option for pediatric patients with intractable epilepsy whose seizure foci are not candidates for resection.
- This study focuses on RNS in pediatric and young adults, comparing thalamic and nonthalamic lead implantation outcomes.
Purpose of the Study:
- To evaluate the safety and seizure outcomes of responsive neurostimulation (RNS) in pediatric and young adult patients with intractable epilepsy.
- To specifically analyze differences in outcomes between thalamic and nonthalamic RNS lead placements.
Main Methods:
- A retrospective review of pediatric and young adult patients who underwent RNS implantation between 2019 and 2023.
- Inclusion criteria focused on patients with drug-resistant epilepsy not eligible for seizure focus resection.
- Data analysis compared outcomes between patients with thalamic versus nonthalamic RNS targets.
Main Results:
- Twenty-four patients (mean age 13.8 years) were included, with 7 thalamic and 17 nonthalamic targets.
- Median seizure reduction was 74% overall, with 68% in the nonthalamic group and 80% in the thalamic group (nonsignificant difference).
- Adverse events were low, including one wound infection and one lead repositioning (8.3% total).
Conclusions:
- Responsive neurostimulation (RNS) is a safe and effective method for reducing seizure burden in pediatric and young adult epilepsy patients when resection is not feasible.
- Both thalamic and nonthalamic RNS targeting strategies result in significant seizure reduction.
- The findings support the use of RNS as an appropriate treatment for this patient population.
Background And Objectives:
Epilepsy is a significant cause of morbidity and has negative effects on cognitive and psychosocial development in pediatric and young adult patients. For pediatric patients who have epileptogenic foci that are poorly localized, deep, bilateral, or in eloquent regions and are not candidates for resection, responsive neurostimulation (RNS) may be an option. The study objective was to demonstrate safety and seizure outcomes from RNS in pediatric and young adults with intractable epilepsy with a specific focus on differences between thalamic and nonthalamic RNS lead implantation.
Methods:
The authors describe a single institution's experience with RNS in patients with drug-resistant epilepsy who were not candidates for seizure focus resection. An Institutional Review Board-approved retrospective review was conducted of all pediatric and young adult patients who underwent RNS implantation at Cincinnati Children's Hospital Medical Center between 2019 and 2023.
Results:
In total, 24 patients met the inclusion criteria for the study. Seven had thalamic targets whereas 17 had nonthalamic targets. The mean patient age at the time of surgery was 13.8 years (range 5-30), with a mean follow-up of 13 months. Thirteen patients (54%) had prior surgery for seizure control. The median global seizure percentage reduction was 68% in the nonthalamic group and 80% in the thalamic group, a nonsignificant difference, resulting in a reduction of 74% for all study patients ( P = .816). Two adverse events (8.3%) included a wound infection and a lead repositioning.
Conclusion:
RNS implantation in pediatric and young adult patients with epilepsy seems to be a safe and efficacious modality for lowering seizure burden in cases where resection of epileptogenic foci is not a viable option. Thalamic and nonthalamic RNS targeting both lead to impactful seizure reduction. This study adds to the growing body of evidence suggesting that RNS is appropriate in pediatric and young adult patients.
