Responsive Neurostimulation of Thalamic and Nonthalamic Targets in Pediatric and Young Adult Patients With Intractable Epilepsy.

Abstract

Epilepsy is a significant cause of morbidity and has negative effects on cognitive and psychosocial development in pediatric and young adult patients. For pediatric patients who have epileptogenic foci that are poorly localized, deep, bilateral, or in eloquent regions and are not candidates for resection, responsive neurostimulation (RNS) may be an option. The study objective was to demonstrate safety and seizure outcomes from RNS in pediatric and young adults with intractable epilepsy with a specific focus on differences between thalamic and nonthalamic RNS lead implantation. The authors describe a single institution's experience with RNS in patients with drug-resistant epilepsy who were not candidates for seizure focus resection. An Institutional Review Board-approved retrospective review was conducted of all pediatric and young adult patients who underwent RNS implantation at Cincinnati Children's Hospital Medical Center between 2019 and 2023. In total, 24 patients met the inclusion criteria for the study. Seven had thalamic targets whereas 17 had nonthalamic targets. The mean patient age at the time of surgery was 13.8 years (range 5-30), with a mean follow-up of 13 months. Thirteen patients (54%) had prior surgery for seizure control. The median global seizure percentage reduction was 68% in the nonthalamic group and 80% in the thalamic group, a nonsignificant difference, resulting in a reduction of 74% for all study patients ( P = .816). Two adverse events (8.3%) included a wound infection and a lead repositioning. RNS implantation in pediatric and young adult patients with epilepsy seems to be a safe and efficacious modality for lowering seizure burden in cases where resection of epileptogenic foci is not a viable option. Thalamic and nonthalamic RNS targeting both lead to impactful seizure reduction. This study adds to the growing body of evidence suggesting that RNS is appropriate in pediatric and young adult patients.