Responsive Neurostimulation in Pediatric Refractory Epilepsy: Findings from the PERC (Pediatric Epilepsy Research Consortium) Epilepsy Surgery Subgroup
Abstract number :
3.323
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1826309
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Rani Singh, MD - Atrium Health/Levine Children's Hospital; Allyson Alexander - University of Colorado Anschutz Medical Campus; Krista Eschbach - University of Colorado Anschutz Medical Campus; Shannon Conrad - Cook Children's Medical Center; Lily Wong-Kisiel - Mayo Clinic College of Medicine; Joseph Sullivan - UCSF Benioff Children's Hospital; Adam Numis - UCSF Benioff Children's Hospital; Kurtis Auguste - UCSF Benioff Children's Hospital; Patricia Pena-Artiles - Icahn School of Medicine at Mount Sinai; Adam Ostendorf - Nationwide Children’s Hospital at the Ohio State School of Medicine.; Shilpa Reddy - Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center; Dewi Depositario-Cabacar - Children’s National Medical Center; Nancy McNamara - University of Michigan; Erin Fedak Romanowski - University of Michigan; Jeffrey Bolton - Boston Children's Hospital; Michael Ciliberto - University of Iowa; Jason Coryell - Oregon Health Sciences University; Satyanarayana Gedela - Children's HealthCare of Atlanta; Zachary Greenspan - Cornell University; Samir Karia - University of Louisville; Jennifer Koop - Medical College of Wisconsin; Ahmad Marashly - Seattle Children’s Hospital; Patricia McGoldrick - Boston Children's Health Physicians; Srishti Nangia - Cornell University; Daniel Shrey - Children’s Hospital of Orange County; Priya Tatachar - Lurie Children’s Hospital; Steven Wolf - Boston Children's Health Physicians; M. Scott Perry - Justin Neurosciences Center, Cook Children’s Medical Center
Rationale: Responsive Neurostimulation (RNS), a closed-loop intracranial electrical stimulation system, is a palliative surgical option for patients with identified seizure foci with drug resistant epilepsy (DRE) who are not candidates for resective surgery. Although this device is FDA approved for patients over 18 years of age, many pediatric epilepsy centers offer RNS to appropriately selected patients. We characterized patients from a multi-center pediatric epilepsy surgery database who were deemed candidates for RNS.
Methods: We prospectively enrolled patients 0-18 years of age undergoing epilepsy surgery evaluation at 20 pediatric epilepsy centers from the PERC (Pediatric Epilepsy Research Consortium) Epilepsy Surgery Database. Patients implanted with RNS were included for analysis. Predefined variables collected included demographics, epilepsy characteristics, presurgical treatment, evaluation, surgical therapy, and outcome. Data was analyzed from project inception (1/2018) to present (5/2021).
Results: Of 1037 patients included in the database, 36 received RNS. Mean age of epilepsy onset was 6.6 years (range 0.1-15.3 years; Table 1) and mean age at referral for phase I evaluation was 14.2 years (range 5-18 years). Most patients had a single seizure type (61%). The mean number of failed anti-seizure medications was 4 (range 1-15) with most taking ≥ 2 at phase I evaluation (89%). Five had previously trialed dietary therapy (14%) and 11 (31%) had prior surgery (8 resective, 3 palliative). Most (81%) had phase 2 evaluation (23 with SEEG, 3 with subdural electrodes, 3 with both; Table 2). The most common known etiology of epilepsy was structural (n=16; 44%). Mean age at implantation was 15.4 years (range 8.6-21 years) and mean duration of epilepsy was 8.8 years. Most patients (61%) received two implanted electrodes with the rest receiving 3 (25%) or 4 (14%). Reasons for RNS implantation included proximity of the epileptogenic zone to eloquent cortex (n=18, 50%), multifocal seizure onset (n=13, 36%), or a combination. Reported complications occurred in 1 patient (2.7%) including a malpositioned lead and transient weakness. Short-term outcomes were available for 30 patients (83%) with a mean duration of 8.2 months (range 1-25 months). A majority (57%) reported ≥ 50% seizure reduction, including three patients (8%) with complete clinical seizure freedom at a mean duration of follow up of 12 months.
Conclusions: For young patients with DRE who are not candidates for surgical resection, palliative surgical options should be considered. Although RNS is presently off-label for patients < 18 years, our longitudinal cohort demonstrates a very good safety profile and promising short-term outcomes in the treatment of refractory epilepsy for this age group.
Funding: Please list any funding that was received in support of this abstract.: There was no funding for this abstract.
Surgery