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Deep brain stimulation outcomes in pediatric drug-resistant epilepsy: A systematic review and meta-analysis
Asmaa Mhanna1, Michael A Ciliberto1, Sreenath Thati Ganganna1
1Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Objective:
Deep brain stimulation (DBS) is an emerging treatment option for pediatric drug-resistant epilepsy (DRE), but evidence regarding its long-term efficacy and safety remains limited. We aimed to assess the long-term efficacy and safety of DBS in children with DRE at a minimum follow-up of 12 months.
Methods:
A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, and the Cochrane Library were searched through November 18, 2025. The primary outcomes were the proportions of patients achieving ≥50% seizure reduction (responder rate) and seizure freedom at ≥12 months after DBS. Subgroup analyses were performed by stimulated target nucleus, and meta-regression assessed the effect of age on treatment response. Secondary outcomes included overall, major, and minor adverse events. Random-effects models were used for all analyses.
Results:
Nineteen studies including 149 pediatric patients met the inclusion criteria. The pooled responder rate at ≥12 months was 63.3% (95% CI, 53.2%-72.3%; I²=3%). Age at implantation was not associated with treatment response (β=-0.049, p = 0.648). Responder rates were 66.2% for centromedian nucleus (CM) stimulation, 46.2% for anterior nucleus of the thalamus (ANT), 76.8% for subthalamic nucleus (STN), and 51.1% for combined CM+ANT stimulation, with no significant between-target differences (p = 0.49). The pooled seizure freedom rate was 13.8% (95% CI, 8.2%-22.3%; I²=0%). Across 17 studies, pooled overall, major, and minor adverse event rates were 16.5%, 10.8%, and 12.5%, respectively. No procedure-related mortality was reported.
Significance:
DBS provides clinically meaningful long-term seizure reduction in approximately two-thirds of pediatric patients with DRE, with an acceptable safety profile. Although CM stimulation demonstrated the highest responder rate among the most extensively studied targets, efficacy did not differ significantly by stimulation target. Larger prospective multicenter studies are needed to establish optimal target selection and evaluate long-term outcomes.
