Deep brain stimulation in pediatric drug-resistant epilepsy: Implications for the developing connectome

Area of Science:

• Neurology
• Pediatric Epilepsy
• Brain Network Disorders

Background:

• Epilepsy is increasingly viewed as a brain network disorder.
• Intracranial neuromodulation is a therapeutic option for drug-resistant epilepsy (DRE).
• Pediatric application of neuromodulation requires careful consideration of brain development.

Purpose of the Study:

• To review the emerging role of deep brain stimulation (DBS) for DRE in children and adolescents.
• To synthesize neurobiological rationale and clinical evidence for pediatric DBS.
• To discuss unique considerations for chronic intracranial stimulation in the developing brain.

Main Methods:

• Review of current evidence on DBS for pediatric epilepsy.
• Synthesis of neurobiological rationale for thalamic and limbic targets.
• Critical review of available clinical data, including prospective studies.

Main Results:

• DBS is increasingly used in specialized pediatric epilepsy care, though largely off-label.
• Evidence synthesis covers seizure outcomes, quality of life, neurodevelopment, and safety.
• Surgical, clinical, and ethical considerations for pediatric DBS are discussed.

Conclusions:

• Pediatric DBS for DRE requires further high-quality, multicenter research.
• Future directions include network-informed targets and developmentally relevant outcome measures.
• Balancing seizure control with long-term neurodevelopmental and psychosocial outcomes is crucial.