Authors :
Presenting Author: Kholoud Altarazi, MD – University Of Mississippi
Cristina Trandafir, MD – Baylor College of Medicine/Texas Children's Hospital
Kimberly Houck, MD – Baylor College of Medicine/Texas Children's Hospital
Irfan Ali, MD – Baylor College of Medicine/Texas Children's Hospital
Daniel Curry, MD – Baylor College of Medicine/Texas Children's Hospital
Deepankar Mohanty, MD – Baylor College of Medicine/Texas Children's Hospital
Sonali Sen, MD – Baylor College of Medicine/Texas Children's Hospital
Anuranjita Nayak, MD – Baylor College of Medicine/Texas Children's Hospital
Rationale:
Thalamic Responsive Neurostimulation (RNS) is an emerging therapy for patients with Drug Resistant Epilepsy (DRE) who are not candidates for resective surgery. While the anterior nucleus (ANT) and centromedian nucleus (CM) of the thalamus are the most targeted sites, there is limited data on the efficacy of pulvinar nucleus (PUL) neuromodulation. We describe six cases of DRE with unilateral pulvinar RNS managed at Texas Children's Hospital.Methods:
This is a single center, retrospective chart review study of all patients with pulvinar RNS treated at Texas Children's Hospital from 2020-2025. All patients had one pulvinar and one cortical RNS lead. The primary outcome was the percentage of seizure reduction as reported by the patient and/or caregiver during each follow-up visit. Responders were defined as patients with 50% reduction in disabling seizures. Secondary outcomes included seizure severity and duration. Stimulation parameters, including stimulation frequency and maximum charge density at the pulvinar lead, were assessed.Results:
A total of seven pediatric patients (2 M, 5 F) with pulvinar RNS leads were reviewed; 6 had more than 6 months of follow-up and were included in the analysis. Seizure onset was between 2 - 9 years of age. The median age at RNS placement was 16 yrs (R, 14-18), median age at last visit was 18 yrs (R, 15-20), and median follow-up was 15 months (R, 6-24). All patients underwent intracranial SEEG monitoring to guide RNS placement, with seizure onsets from the posterior temporal, parietal, cingulate, and/or occipital lobes. The majority (4/6) had a structural abnormality on brain MRI (focal cortical dysplasia, 3; porencephalic cyst, 1). One patient had a diagnosis of electrical status epilepticus in sleep (ESES). The median number of concurrent antiseizure medications was 3. Half (3/6) had previous procedures (concurrent focal ablation, 2VNS, 1).
At 18 months follow-up, the responder rate was 60% (3/5). Two patients were followed for >18 months, one with ESES showing improvement in ipsilateral spike-wave index but no clinical improvement, the other patient maintained >50% seizure reduction.
Medication adjustments were continued during follow-up visits, and device programming was adjusted according to response. Maximum PUL charge density ranged from 1.0-3.5 uC/cm2. No significant surgical or stimulation-related adverse effects were reported.
Conclusions:
The overall responder rate in patients treated with pulvinar thalamo-cortical responsive neurostimulation was 60% at 18 months follow-up. Overall, patients experienced meaningful improvement in their epilepsy, though this response varied over time and often required adjustments in medications and stimulation settings. This study suggests that pulvinar RNS may benefit selected patients with DRE. Further larger cohorts with extended follow-up are needed to better define efficacy and long-term outcomes.Funding: NA