Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies
Abstract Objective Neuromodulation for pediatric refractory epilepsy (PRE) is preferred when the seizure onset zone is not amenable to surgical resection, due to multifocal onset or involvement of eloquent cortex. Given its rapidly evolving landscape, we describe our institutional experience with ne...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-06-01
|
| Series: | Epilepsia Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/epi4.70006 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850223383003791360 |
|---|---|
| author | Rohin Singh Megan M. J. Bauman Karimul Islam Panagiotis Kerezoudis Sanjeet S. Grewal Jonathon J. Parker Jamie J. Van Gompel Kai J. Miller Brian N. Lundstrom Keith Starnes |
| author_facet | Rohin Singh Megan M. J. Bauman Karimul Islam Panagiotis Kerezoudis Sanjeet S. Grewal Jonathon J. Parker Jamie J. Van Gompel Kai J. Miller Brian N. Lundstrom Keith Starnes |
| author_sort | Rohin Singh |
| collection | DOAJ |
| description | Abstract Objective Neuromodulation for pediatric refractory epilepsy (PRE) is preferred when the seizure onset zone is not amenable to surgical resection, due to multifocal onset or involvement of eloquent cortex. Given its rapidly evolving landscape, we describe our institutional experience with neurostimulation therapies including deep brain stimulation (DBS) of the anterior nucleus (DBS‐ANT), the centromedian nucleus (DBS‐CM), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS) to treat PRE. Methods A retrospective chart review was conducted to identify pediatric patients (≤18 years of age) who presented to our institution with PRE. Patients were included who had at least 1 year of follow‐up after neurostimulation was started. Patients with ≥50% seizure frequency reduction at last follow‐up compared to baseline were classified as responders. Results A total of 35 patients (21 females) were included in the series. Nine patients underwent DBS‐ANT, 9 underwent DBS‐CM (+ ANT in 7 patients), 5 underwent RNS, and 12 underwent CSS. The median age at seizure onset and surgery was 8 and 16 years, respectively. Structural lesions were the most common etiology of epilepsy (54%). Eighteen patients had prior interventions and 13 received invasive EEG. Post‐operative complications following neurostimulation implantation were noted in three patients (9%). However, no permanent deficits were noted. Median follow‐up time was 46 months (range 13–162 months). Twenty‐three patients (59%) were responders (3/9 DBS‐ANT; 7/9 DBS‐CM; 4/5 RNS; 9/12 CSS). Further, median seizure reduction was 25% (DBS‐ANT), 89% (DBS‐CM), 87% (RNS), and 88% (CSS) across the cohort. Six patients (17%) had improved subjective neurocognitive outcomes while the other 29 had stable neurocognitive outcomes. Significance DBS, RNS, and CSS are safe and effective options for PRE. An understanding of treatment approaches can optimize results by tailoring therapy to individual patients. Plain Language Summary This study investigates the use of various neurostimulation therapies for treating pediatric refractory epilepsy (PRE) including deep brain stimulation (DBS), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS). Overall, neuromodulation was found to be effective in reducing seizures in most patients, with 59% of patients showing at least a 50% reduction in seizure frequency. Additionally, the treatments were generally safe, with few complications and no instances of permanent deficits. |
| format | Article |
| id | doaj-art-88dff9ec43d6455d9e3ad236a79122ea |
| institution | OA Journals |
| issn | 2470-9239 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj-art-88dff9ec43d6455d9e3ad236a79122ea2025-08-20T02:05:59ZengWileyEpilepsia Open2470-92392025-06-0110369470410.1002/epi4.70006Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapiesRohin Singh0Megan M. J. Bauman1Karimul Islam2Panagiotis Kerezoudis3Sanjeet S. Grewal4Jonathon J. Parker5Jamie J. Van Gompel6Kai J. Miller7Brian N. Lundstrom8Keith Starnes9Department of Neurosurgery University of Rochester Rochester New York USADepartment of Neurosurgery Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USADepartment of Neurosurgery Mayo Clinic Rochester Minnesota USADepartment of Neurosurgery Mayo Clinic Jacksonville Florida USADepartment of Neurosurgery Mayo Clinic Phoenix Arizona USADepartment of Neurosurgery Mayo Clinic Rochester Minnesota USADepartment of Neurosurgery Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USAAbstract Objective Neuromodulation for pediatric refractory epilepsy (PRE) is preferred when the seizure onset zone is not amenable to surgical resection, due to multifocal onset or involvement of eloquent cortex. Given its rapidly evolving landscape, we describe our institutional experience with neurostimulation therapies including deep brain stimulation (DBS) of the anterior nucleus (DBS‐ANT), the centromedian nucleus (DBS‐CM), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS) to treat PRE. Methods A retrospective chart review was conducted to identify pediatric patients (≤18 years of age) who presented to our institution with PRE. Patients were included who had at least 1 year of follow‐up after neurostimulation was started. Patients with ≥50% seizure frequency reduction at last follow‐up compared to baseline were classified as responders. Results A total of 35 patients (21 females) were included in the series. Nine patients underwent DBS‐ANT, 9 underwent DBS‐CM (+ ANT in 7 patients), 5 underwent RNS, and 12 underwent CSS. The median age at seizure onset and surgery was 8 and 16 years, respectively. Structural lesions were the most common etiology of epilepsy (54%). Eighteen patients had prior interventions and 13 received invasive EEG. Post‐operative complications following neurostimulation implantation were noted in three patients (9%). However, no permanent deficits were noted. Median follow‐up time was 46 months (range 13–162 months). Twenty‐three patients (59%) were responders (3/9 DBS‐ANT; 7/9 DBS‐CM; 4/5 RNS; 9/12 CSS). Further, median seizure reduction was 25% (DBS‐ANT), 89% (DBS‐CM), 87% (RNS), and 88% (CSS) across the cohort. Six patients (17%) had improved subjective neurocognitive outcomes while the other 29 had stable neurocognitive outcomes. Significance DBS, RNS, and CSS are safe and effective options for PRE. An understanding of treatment approaches can optimize results by tailoring therapy to individual patients. Plain Language Summary This study investigates the use of various neurostimulation therapies for treating pediatric refractory epilepsy (PRE) including deep brain stimulation (DBS), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS). Overall, neuromodulation was found to be effective in reducing seizures in most patients, with 59% of patients showing at least a 50% reduction in seizure frequency. Additionally, the treatments were generally safe, with few complications and no instances of permanent deficits.https://doi.org/10.1002/epi4.70006epilepsy neurostimulationneuromodulationpediatric DBSpediatric epilepsypediatric neurostimulationpediatric RNS |
| spellingShingle | Rohin Singh Megan M. J. Bauman Karimul Islam Panagiotis Kerezoudis Sanjeet S. Grewal Jonathon J. Parker Jamie J. Van Gompel Kai J. Miller Brian N. Lundstrom Keith Starnes Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies Epilepsia Open epilepsy neurostimulation neuromodulation pediatric DBS pediatric epilepsy pediatric neurostimulation pediatric RNS |
| title | Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies |
| title_full | Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies |
| title_fullStr | Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies |
| title_full_unstemmed | Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies |
| title_short | Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies |
| title_sort | intracranial stimulation for pediatric refractory epilepsy a single institutional experience using evolving therapies |
| topic | epilepsy neurostimulation neuromodulation pediatric DBS pediatric epilepsy pediatric neurostimulation pediatric RNS |
| url | https://doi.org/10.1002/epi4.70006 |
| work_keys_str_mv | AT rohinsingh intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT meganmjbauman intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT karimulislam intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT panagiotiskerezoudis intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT sanjeetsgrewal intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT jonathonjparker intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT jamiejvangompel intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT kaijmiller intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT briannlundstrom intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies AT keithstarnes intracranialstimulationforpediatricrefractoryepilepsyasingleinstitutionalexperienceusingevolvingtherapies |