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Thalamic Responsive Neurostimulation After Anatomic Hemispherectomy With Direct Targeting.

Amanda N Stanton1,2, Mallory Dacus2, Dario J Englot3

  • 1Department of Neurosurgery, University of Florida Health Shands, Gainesville, FL, USA.

Journal of Child Neurology
|March 13, 2026
PubMed
Summary
This summary is machine-generated.

Responsive neurostimulation (RNS) offers a new treatment for drug-resistant epilepsy (DRE). This case study shows RNS of thalamic nuclei successfully reduced seizures in a pediatric patient with complex DRE.

Keywords:
epilepsyneuroradiologyneurosurgerysurgery

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Area of Science:

  • Neurology
  • Neurosurgery
  • Epilepsy Research

Background:

  • Drug-resistant epilepsy (DRE) affects nearly one-third of epilepsy patients.
  • Responsive neurostimulation (RNS) of thalamic nuclei is an emerging treatment for DRE.
  • Previous treatments like vagal nerve stimulation were insufficient for this patient.

Purpose of the Study:

  • To present a complex case of pediatric DRE treated with thalamic RNS.
  • To discuss the technical challenges and successful application of RNS in a patient with unique neuroanatomy.

Main Methods:

  • The patient had DRE secondary to left hemimegencephaly after hemispherectomy.
  • Responsive neurostimulation (RNS) targeting the right centromedian (CM) and anterior nucleus (ANT) thalamic nuclei was implanted.
  • Advanced MRI sequences were utilized for precise targeting.

Main Results:

  • One year post-RNS implantation, the patient achieved over 50% seizure frequency reduction.
  • Successful targeting of CM and ANT nuclei was achieved despite anatomical challenges.
  • The patient demonstrated significant improvement in seizure control.

Conclusions:

  • Thalamic RNS is a viable and effective treatment option for select pediatric patients with DRE.
  • Advanced imaging techniques are crucial for overcoming anatomical complexities in RNS targeting.
  • This case highlights the potential of RNS in managing refractory epilepsy in complex pediatric cases.