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Oral Presentation

Pediatric

Intracranial Stimulation for Pediatric Refractory Epilepsy: A Single Institutional Experience using Evolving Therapies

Saturday, May 4, 2024
2:43 PM – 2:48 PM CT
Location:  S401cd
Disclosure(s):
Megan M.J Bauman, M.S.: No financial relationships to disclose
Sanjeet Singh Grewal, MD: No financial relationships to disclose
Introduction: Neurostimulation for pediatric refractory epilepsy (PRE) is a rapidly developing field with various treatment options now available. This treatment is often preferred when seizures do not respond to medications and/or the epileptogenic zone is not amenable to surgical resection, due to multifocal onset or involvement of eloquent cortex. We describe our institutional experience with novel 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 with ≥ 50% seizure frequency reduction at last follow-up compared to baseline were classified as responders.

Results: A total of 40 patients (23 females) were included in the series. Eleven patients underwent DBS-ANT, three underwent DBS-CM, eight underwent DBS-CM+ANT, five underwent RNS, and thirteen underwent CSS. The average age at seizure onset and surgery was 6.6 and 15.2 years, respectively. Nineteen patients had prior interventions (two neocortical resections, two mesial temporal resection, one ablation + VNS, three corpus callosotomy + VNS, and eleven VNS alone). Transient complications following neurostimulation implantation were noted in four patients (10%). However, no permanent deficits were noted. Average follow-up time was 37 months (range 4-122 months). 25 patients (63%) were responders (8/11 DBS-ANT; 1/3 DBS-CM; 4/8 DBS-ANT+CM; 4/5 RNS; 8/13 CSS). Seven patients (18%) had improved neurocognitive outcomes while the other 33 (82%) had stable neurocognitive outcomes; no patients experienced worse postoperative neurocognitive outcomes. Additionally, eight patients (20%) had a reduction in their AEDs at most recent follow-up (5/11 DBS-ANT; 1/8 DBS-CM+ANT; 2/13 CSC).

Conclusion : DBS, RNS, and CSS are safe and effective options for PRE. An understanding of treatment mechanisms can optimize results by tailoring therapy to individual patients.