Special Considerations for Personalization in Pediatric Intracranial Neuromodulation.

Area of Science:

• Neurology
• Neurosurgery
• Pediatric Epilepsy

Background:

• Drug-resistant epilepsy (DRE) in children poses significant management challenges.
• Neuromodulation therapies, often approved for adult indications, require careful consideration for pediatric use.

Purpose of the Study:

• To review the current landscape of intracranial neuromodulation for pediatric DRE.
• To highlight evidence, special circumstances, and emerging trends in pediatric neuromodulation.

Main Methods:

• Literature review of pediatric neuromodulation studies.
• Discussion of the only randomized clinical trial in pediatric developmental and epileptic encephalopathy.
• Exploration of StereoEEG in thalamic nuclei for presurgical monitoring.

Main Results:

• Limited but growing evidence supports neuromodulation in pediatric DRE.
• StereoEEG implantation of thalamic nuclei is an emerging trend for personalized therapy.
• Off-label use for pediatric DRE faces insurance approval hurdles.

Conclusions:

• Intracranial neuromodulation offers potential for pediatric DRE but requires careful navigation of challenges.
• Personalized therapy through advanced monitoring like StereoEEG is a promising direction.
• Addressing insurance and regulatory aspects is crucial for wider adoption.