Preliminary Outcomes of Central Responsive Neurostimulation for Multifocal Epilepsy in Pediatric Patients
Marian Michael Bercu1, Kathryn E Spykman2, Velisa M Johnson3
1Division of Pediatric Neurosurgery, Helen DeVos Children's Hospital, Corewell Health, Grand Rapids, Michigan.
Insights
Responsive neurostimulation (RNS) shows promise for pediatric drug-resistant epilepsy (DRE). This treatment led to significant seizure reduction and improved quality of life in most young patients with multifocal DRE.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neurostimulation
Background:
- Drug-resistant epilepsy (DRE) presents significant challenges in pediatric patients.
- Limited surgical options exist for multifocal DRE in children.
Purpose of the Study:
- To evaluate the preliminary outcomes of centromedian responsive neurostimulation (RNS) in pediatric patients with multifocal DRE.
- To assess the safety and efficacy of RNS in this population.
Main Methods:
- Retrospective chart review of 11 pediatric patients with multifocal epilepsy treated with bilateral centromedian RNS.
- Analysis of seizure reduction, subjective improvements, and complications.
Main Results:
- 90% of patients achieved at least a 50% seizure reduction.
- 6 patients (55%) experienced over 75% seizure reduction.
- 8 patients (72%) reported subjective improvements in behavior and academics; 90% reported improved quality of life. No complications were observed.
Conclusions:
- Centromedian RNS demonstrates a robust response and excellent safety profile in pediatric multifocal DRE.
- Neurostimulation offers a promising therapeutic option for challenging pediatric epilepsy cases.
Background:
Drug-resistant epilepsy (DRE) in the pediatric population is a challenging disease, with limited surgical interventions available. We report the preliminary outcomes for pediatric patients with multifocal DRE epilepsy treated with centromedian responsive neurostimulation.
Methods:
A retrospective chart review was conducted in 11 pediatric patients with multifocal epilepsy who were treated with bilateral responsive neurostimulation (RNS) of the centromedian nucleus. All patients were implanted with at least one RNS system; three patients had two RNS systems implanted, with additional leads targeting bilateral cortical or subcortical epileptogenic areas.
Results:
Ten out of the 11 patients (90%) treated with RNS (ages 5-20 years old, average 13.73 years old, median 14 years old) were found to have at least a 50% reduction in seizures using at least two modalities of data analysis. The average follow-up time was 1.33 years. Upon reviewing the data from the electronic medical records, 6 patients (55%) experienced a reduction in seizures of 75% or higher, 4 patients (36%) experienced a reduction in seizures between 50 and 74% and 1 patient (9%) was nonresponsive. At least 8 patients (72%) experienced subjective improvements in behavior, interactions, and/or academic performance. This was most pronounced in the subgroup of 4 patients diagnosed with autism spectrum disorder. Ninety percent of patients and families reported improvements in quality of life secondary to neurostimulation. No surgical or stimulation-related complications or side effects were encountered.
Conclusions:
The preliminary outcomes suggest a robust response to central neurostimulation in pediatric patients suffering from multifocal DRE, with an excellent safety profile.
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