Treatment of Pediatric Drug-Resistant Generalized Epilepsy with Responsive Neurostimulation of the Centromedian Nucleus of the Thalamus: A Case Series of Seven Pediatric Patients
Abstract number :
2.329
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
609
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Mikaela Speakes, MD – UPMC Children's Hospital of Pittsburgh
Kiersten Reznik, PA-C – UPMC Children's Hospital of Pittsburgh; Taylor Abel, MD – UPMC Children's Hospital of Pittsburgh; William Welch, MD – UPMC Children's Hospital of Pittsburgh
Rationale: Responsive neurostimulation (RNS) at the area of seizure focus is effective for treatment of drug-resistant focal epilepsy in patients who are not candidates for surgical resection.1 RNS of the centromedian (CM) nucleus of the thalamus (CM-RNS) is being investigated for treatment of generalized epilepsy given the role the thalamus plays in the generation and spread of epileptiform activity.2 Results in adults and a small number of pediatric cases are promising.3,4 Here we describe our center's experience with CM-RNS for the treatment of pediatric drug-resistant generalized epilepsy.
1 Heck CN, King-Stephen D, Massey AD, Nair DR, Jobst BC, Barkley GL, et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: Final results of the RNS System Pivotal trial. Epilepsia 2014;55(3):432-441.
2 Warsi NM, Yan H, Suresh H, Wong SM, Arski ON, Gorodetsky C, et al. The anterior and centromedian thalamus: Anatomy, function, and dysfunction in epilepsy. Epilepsy Res 2022;182:106913.
3 Roa JA, Abramova M, Fields M, La Vega-Talbott M, Yoo J, Marcuse L, et al. Responsive neurostimulation of the thalamus for the treatment of refractory epilepsy. Front Hum Neurosci 2022;16:926337.
4 Curtis K, Hect JL, Harford E, Welch WP, Abel TJ. Responsive neurostimulation for pediatric patients with drug resistant epilepsy: A case series and review of the literature. Neurosurg Focus 2022;53(4):E10.
Methods: We performed a retrospective review of patients who underwent CM-RNS for drug-resistant generalized epilepsy. Seven patients (age eight to twenty, four females) were identified. Five patients had a diagnosis of idiopathic/genetic generalized epilepsy, and two patients had a diagnosis of Lennox-Gastaut syndrome. Seizure types included generalized tonic-clonic, myoclonic, atonic, and absence. Follow-up time after initiation of stimulation ranged from three to 34 months. Pre and post implantation seizure frequency was obtained from patient and caregiver reports, and long-term electrocorticography data was reviewed. Our primary outcome was change in seizure frequency at last follow up appointment compared to pre-implantation baseline.
Results: Five patients (71%) reported improvement in seizure frequency and severity, with one patient achieving clinical seizure freedom. Two patients had no significant improvement in seizure frequency and required additional anti-seizure medications post-implantation. There were no serious adverse events including post-operative infection, stroke, or device malfunction. One patient developed transient left upper extremity weakness post-operatively that resolved within two weeks, and one patient developed a pseudomeningocele that resolved by post-operative day six.
Conclusions: CM-RNS is safe and may improve seizure frequency in pediatric drug-resistant generalized epilepsy. Larger systematic studies with longer follow-up times and standardized outcome measures are needed to determine long-term effectiveness and optimal patient selection for thalamic RNS.
Funding: N/A
Surgery