Responsive neurostimulation for the treatment of medically refractory epilepsy in pediatric patients: strategies, outcomes, and technical considerations

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  • 1 Georgetown University School of Medicine;
  • 2 Department of Neurological Surgery, George Washington University; and
  • 3 Department of Neurosurgery, Children’s National Hospital, Washington, DC
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OBJECTIVE

Children with medically refractory partial-onset epilepsy arising from eloquent cortex present a therapeutic challenge, as many are not suitable for resective surgery. For these patients, responsive neurostimulation may prove to be a potential tool. Although responsive neurostimulation has demonstrated utility in adults, little has been discussed regarding its utility in the pediatric population. In this study, the authors present their institution’s experience with responsive neurostimulation via the RNS System through a case series of 5 pediatric patients.

METHODS

A single-center retrospective study of patients who underwent RNS System implantation at Children’s National Hospital was performed.

RESULTS

Five patients underwent RNS System implantation. The mean patient age at treatment was 16.8 years, and the average follow-up was 11.2 months. All patients were considered responders, with a seizure frequency reduction of 64.2% without adverse events.

CONCLUSIONS

All 5 patients experienced medium-term improvements in seizure control after RNS System implantation with decreases in seizure frequency > 50% from baseline preoperative seizure frequency. The authors demonstrated two primary configurations of electrode placement: hippocampal or amygdala placement via an occipitotemporal trajectory, as well as infratemporal surface electrodes and surface electrodes on the primary motor cortex. No adverse events were experienced in this case series.

ABBREVIATIONS EEG = electroencephalography; FCD = focal cortical dysplasia; fMRI = functional MRI; IEEG = intracranial EEG; MRE = medically refractory epilepsy; MST = multiple subpial transection; MTS = mesial temporal sclerosis; SEEG = stereo-EEG; VEEG = video-EEG; VNS = vagus nerve stimulation.

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Contributor Notes

Correspondence Chima O. Oluigbo: Children’s National Hospital, Washington, DC. coluigbo@childrensnational.org.

INCLUDE WHEN CITING Published online April 30, 2021; DOI: 10.3171/2020.11.PEDS20660.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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