Authors :
Presenting Author: Alexander Lopez, MD – University of California Irvine
Daniel Sherlock, Student – Research Intern, Sargent College of Health and Rehabilitation Sciences, Boston University; Sarah Pedroza, MS, PA-C – Physicians Assistant, Neurosurgery, Children's Hospital of Orange County; Jordan Davies, MD – Resident Physician, Department of Neurological Surgery, University of California Irvine; Alexander Lopez, MD – Resident Physician, University of California Irvine, University of California Irvine; David Adams, MD – Neurologist, Division of Neurology, Children's Hospital of Orange County; Maija Steenari, MD – Neurologist, Division of Neurology, Children's Hospital of Orange County; Donald Phillips, MD, MPH – Neurologist, Division of Neurology, Children's Hospital of Orange County; Joffe Olaya, MD – Neurosurgeon, Division of Neurosurgery, Children's Hospital of Orange County
Rationale:
Responsive neurostimulation (RNS, Neuropace, Inc., Mountain View, CA) is a closed loop intracranial electrical stimulation system used for patients with drug resistant epilepsy (DRE). RNS is commonly implanted when surgical resection of an epileptogenic focus lies within eloquent cortex or when epileptogenic foci are located bilaterally. While the efficacy of resective surgery and concomitant placement of RNS has been described in case series within the adult neurosurgical population, to our knowledge, we describe the first series of pediatric patients who underwent lesional resection surgery with adjunctive RNS placement.
Methods:
A retrospective chart analysis was performed from November 2020 to April 2023. Three patients had responsive neurostimulation (RNS) placement in conjunction with epileptogenic focus resection during that time period. Seizure semiology, pre and postoperative antiseizure medication (ASM), seizure frequency, length of hospitalization, and complications were collected.
Results:
Three patients underwent epileptogenic focus resection surgery and concomitant RNS placement after epileptogenic focus was localized with subdural electrode placement. Median age was 12 years old (range 10-16 years), each with an 11-day hospital admission. Cortical stimulation mapping revealed overlapping motor cortex with seizure onset zone (SOZ) in two cases, and overlap with Wernicke’s area in another. There were no immediate perioperative complications. One patient had complete resolution of seizure activity (Engel IA) and one patient had > 90% reduction of seizures (Engel IB) at 2 year follow-up. The most recent patient has been seizure free one month post operation.
Conclusions:
In medically refractory epilepsy cases with epileptogenic foci extending to eloquent cortex, resection of non-eloquent lesional tissue with adjunctive placement of RNS electrodes over eloquent perilesional cortex may offer a safe and effective technique for providing additional seizure reduction in selective pediatric patients.
Funding:
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.