Bilateral centromedian nucleus of thalamus responsive neurostimulation for pediatric‐onset drug‐resistant epilepsy

Neuromodulation therapies offer an efficacious treatment alternative for patients with drug‐resistant epilepsy (DRE), particularly those unlikely to benefit from surgical resection. Here we present our retrospective single‐center case series of patients with pediatric‐onset DRE who underwent respons...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2024-08, Vol.65 (8), p.e131-e140
Main Authors: Ahn, Samuel, Edmonds, Benjamin, Rajaraman, Rajsekar R., Rao, Lekha M., Hussain, Shaun A., Matsumoto, Joyce H., Sankar, Raman, Salamon, Noriko, Fallah, Aria, Nariai, Hiroki
Format: Article
Language:English
Subjects:
Adolescent
centromedian nucleus
Child
Child, Preschool
Convulsions & seizures
Deep Brain Stimulation - methods
Drug Resistant Epilepsy - physiopathology
Drug Resistant Epilepsy - therapy
drug‐resistant epilepsy
EEG
Electrodes, Implanted
Electroencephalography - methods
Epilepsy
epilepsy surgery
Female
Humans
Implantable Neurostimulators
Intralaminar Thalamic Nuclei
Male
Neuromodulation
neurostimulation
Patients
Pediatrics
Retrospective Studies
Seizures
Sensorimotor system
Side effects
Thalamus
Treatment Outcome
Young Adult
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Summary:Neuromodulation therapies offer an efficacious treatment alternative for patients with drug‐resistant epilepsy (DRE), particularly those unlikely to benefit from surgical resection. Here we present our retrospective single‐center case series of patients with pediatric‐onset DRE who underwent responsive neurostimulation (RNS) depth electrode implantation targeting the bilateral centromedian nucleus (CM) of the thalamus between October 2020 and October 2022. Sixteen patients were identified; seizure outcomes, programming parameters, and complications at follow‐up were reviewed. The median age at implantation was 13 years (range 3.6–22). Six patients (38%) were younger than 12 years of age at the time of implantation. Ictal electroencephalography (EEG) patterns during patients’ most disabling seizures were reliably detected. Ten patients (62%) achieved 50% or greater reduction in seizure frequency at a median 1.3 years (range 0.6–2.6) of follow‐up. Eight patients (50%) experienced sensorimotor side effects, and three patients (19%) had superficial pocket infection, prompting the removal of the RNS device. Side effects of stimulation were experienced mostly in monopolar‐cathodal configuration and alleviated with programming change to bipolar configuration or low‐frequency stimulation. Closed‐loop neurostimulation using RNS targeting bilateral CM is a feasible and useful therapy for patients with pediatric‐onset DRE.
ISSN:0013-9580
1528-1167
1528-1167
DOI:10.1111/epi.18031