Responsive Neurostimulation in Drug-Resistant Pediatric Epilepsy: Findings From the Epilepsy Surgery Subgroup of the Pediatric Epilepsy Research Consortium

Singh, Rani K.; Liu, Gang; Wolf, Steven M.; Perry, Μ. Scott; Ostendorf, Adam P.; Wong‐Kisiel, Lily C.; Romanowski, Erin Fedak; McNamara, Nancy; Tatachar, Priyamvada; Depositario-Cabacar, Dewi; Gaillard, William D.; Oluigbo, Chima; Koop, Jennifer I.; Andrade‐Machado, Rene; Javarayee, Pradeep; Alexander, Allyson; Eschbach, Krista; Olaya, Joffre; Shrey, Daniel W.; Singh, RaniK.; Grinspan, Zachary M.; Nangia, Srishti; Karia, Samir; Karakas, Cemal; Bolton, Jeffrey; Ciliberto, Michael A.; Auguste, Kurtis I.; González-Giraldo, Ernesto; Numis, Adam; Sullivan, Joseph; Coryell, Jason; Gedela, Satya; Hauptman, Jason S.; Reddy, Shilpa B.; McCormack, Michael J.; Manuel, Chad M.; Samanta, Debopam; Armstrong, Dallas; Marashly, Ahmad

doi:10.1016/j.pediatrneurol.2023.03.001

Cited by 9 publications

(10 citation statements)

References 37 publications

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“…While the FDA approved DBS in adult epilepsy in 2018, 16 RNS has been approved in the USA since 2013 17 . A large RNS case series involving a total of 56 patients from 22 PERC centers, underscores its popularity in pediatric DRE 6 . In addition to the delayed adoption of DBS, most responding centers perform fewer than five cases annually, whereas six centers perform at least 10 new RNS procedures per year.…”

Section: Discussionmentioning

confidence: 99%

“… 17 A large RNS case series involving a total of 56 patients from 22 PERC centers, underscores its popularity in pediatric DRE. 6 In addition to the delayed adoption of DBS, most responding centers perform fewer than five cases annually, whereas six centers perform at least 10 new RNS procedures per year. This could be related to the lag time between FDA approval and local adoption practices and comfort level.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatments include resection, disconnection, ablation, or electrical modulation of the epileptogenic network 4,5 . Neuromodulation surgery using deep brain stimulation (DBS) or responsive neurostimulation (RNS) is utilized when resection or ablation of the epileptogenic network may have an unacceptable side‐effect profile 6,7 . DBS and RNS are only approved by the Food and Drug Administration (FDA) for adults (>18 years old) but off‐label use in children has increased recently 6,8–12 .…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 5 Neuromodulation surgery using deep brain stimulation (DBS) or responsive neurostimulation (RNS) is utilized when resection or ablation of the epileptogenic network may have an unacceptable side‐effect profile. 6 , 7 DBS and RNS are only approved by the Food and Drug Administration (FDA) for adults (>18 years old) but off‐label use in children has increased recently. 6 , 8 , 9 , 10 , 11 , 12 Despite this increase, data on patient selection criteria, surgical methodologies, postoperative care protocols, and strategies for mitigating or managing complications in the pediatric population is limited.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 DBS and RNS are only approved by the Food and Drug Administration (FDA) for adults (>18 years old) but off‐label use in children has increased recently. 6 , 8 , 9 , 10 , 11 , 12 Despite this increase, data on patient selection criteria, surgical methodologies, postoperative care protocols, and strategies for mitigating or managing complications in the pediatric population is limited. This presents a barrier to optimal patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric neuromodulation for drug‐resistant epilepsy: Survey of current practices, techniques, and outcomes across US epilepsy centers

Joshi,

Karakas,

Eschbach

et al. 2024

Epilepsia Open

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Neuromodulation via Responsive Neurostimulation (RNS) or Deep Brain Stimulation (DBS) is an emerging treatment strategy for pediatric drug‐resistant epilepsy (DRE). Knowledge gaps exist in patient selection, surgical technique, and perioperative care. Here, we use an expert survey to clarify practices. Thirty‐two members of the Pediatric Epilepsy Research Consortium were surveyed using REDCap. Respondents were from 17 pediatric epilepsy centers (missing data in one): Four centers implant RNS only while 13 implant both RNS and DBS. Thirteen RNS programs commenced in or before 2020, and 10 of 12 DBS programs began thereafter. The busiest six centers implant 6–10 new RNS devices per year; all DBS programs implant <5 annually. The youngest RNS patient was 3 years old. Most centers (11/12) utilize MP2RAGE and/or FGATIR sequences for planning. Centromedian thalamic nuclei were the unanimous target for Lennox–Gastaut syndrome. Surgeon exposure to neuromodulation occurred mostly in clinical practice (14/17). Clinically significant hemorrhage (n = 2) or infection (n = 3) were rare. Meaningful seizure reduction (>50%) was reported by 81% (13/16) of centers. RNS and DBS are rapidly evolving treatment modalities for safe and effective treatment of pediatric DRE. There is increasing interest in multicenter collaboration to gain knowledge and facilitate dialogue.Plain language summaryWe surveyed 32 pediatric epilepsy centers in USA to highlight current practices of intracranial neuromodulation. Of the 17 that replied, we found that most centers are implanting thalamic targets in pediatric drug‐resistant epilepsy using the RNS device. DBS device is starting to be used in pediatric epilepsy, especially after 2020. Different strategies for target identification are enumerated. This study serves as a starting point for future collaborative research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%