Neurostimulation in children with drug-resistant epilepsy: strategies in subcortical targeting and systematic review of the evidence
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View abstract on PubMed
Summary
This summary is machine-generated.Subcortical electrode targeting for drug-resistant epilepsy (DRE) in children using deep brain stimulation (DBS) and responsive neurostimulation (RNS) shows significant seizure reduction. A decision-support tool aids pediatric neurosurgeons in selecting targets for improved outcomes.
Area Of Science
- Neurosurgery
- Pediatric Neurology
- Epilepsy Management
Background
- Drug-resistant epilepsy (DRE) in children presents significant management challenges.
- Subcortical electrode implantation via deep brain stimulation (DBS) and responsive neurostimulation (RNS) are therapeutic options.
- Technical considerations for pediatric DRE targeting require specific attention.
Purpose Of The Study
- To outline technical aspects of subcortical electrode targeting in pediatric DRE.
- To introduce a decision-support tool for pediatric neurosurgeons regarding DBS and RNS target selection.
- To analyze outcomes and safety of these interventions in children.
Main Methods
- Systematic review of studies involving pediatric patients (age ≤ 19 years) undergoing DBS or RNS for DRE.
- Screening articles for trajectory planning, imaging, intraoperative workflows, and targeting strategies (direct vs. indirect).
- Analysis of seizure reduction, responder rates, adverse events, and pediatric-specific factors.
Main Results
- Seventeen studies (333 children) were included, with a median age of 16 years and epilepsy duration of 12.15 years.
- Centromedian nucleus (CMN) was the most common target (83.3%) for DBS/RNS.
- Pooled seizure reduction was 54.7%, with a 63.0% responder rate; complication rate was 13.3%.
Conclusions
- Stereotactic subcortical targeting in pediatric DRE is safe and effective, achieving significant seizure reduction.
- Direct and indirect targeting strategies need adaptation for pediatric neuroanatomy.
- A practical tool is provided to assist neurosurgeons in planning and executing these procedures.
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