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Centromedian nucleus targeting in the pediatric population treated with thalamic responsive neurostimulation for

Marian Michael Bercu1, Bahram Sarvi Zargar2, Kathryn E Spykman2

  • 1Division of Pediatric Neurosurgery, Helen DeVos Children's Hospital, Corewell Health, Grand Rapids, Michigan, USA.

Epilepsia Open
|November 13, 2025
PubMed

Insights

Responsive neurostimulation (RNS) targeting the centromedian nucleus (CMN) effectively reduced seizures in pediatric drug-resistant epilepsy (DRE). This safe approach achieved an 80.4% seizure reduction in 83.3% of patients.

Area of Science:

  • Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Drug-resistant epilepsy (DRE) in pediatric patients presents significant management challenges.
  • Neurostimulation of the centromedian nucleus (CMN) of the thalamus is a potential therapeutic strategy.
  • Responsive neurostimulation (RNS) offers a targeted approach for seizure control.

Purpose of the Study:

  • To evaluate the efficacy and safety of RNS targeting the CMN in pediatric DRE.
  • To assess seizure reduction rates and contact localization in relation to outcomes.
  • To report preliminary results from a case series of pediatric patients.

Main Methods:

  • Thirteen pediatric patients with DRE received RNS with direct CMN targeting.
  • Magnetization-Prepared 2 Rapid Gradient-Echo (MP2RAGE) scans and ClearPoint neuronavigation were used for precise electrode placement.
  • Post-operative imaging and probabilistic anatomical models (Freesurfer) confirmed contact localization within the CMN.

Main Results:

  • Ten of 12 patients (83.3%) with multifocal or generalized DRE achieved over 50% seizure reduction.
  • The average seizure reduction rate was 80.4% across the treated cohort.
  • No stimulation-related side effects were reported during an average follow-up of 25.2 months; 95.8% of electrodes had accurate CMN contact.

Conclusions:

  • High-accuracy direct targeting of the CMN with RNS demonstrates robust efficacy in pediatric DRE.
  • This neurostimulation approach is safe and effective for managing challenging pediatric epilepsy cases.
  • Accurate electrode placement is crucial for successful outcomes in CMN-targeted RNS.

Keywords:
centromedian nucleus of thalamusdirect targetingdrug‐resistant epilepsypediatricresponsive neurostimulation

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