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ORIGINAL RESEARCH article

Front. Surg.

Sec. Neurosurgery

Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1569360

This article is part of the Research Topic Rising Stars in Neurosurgery 2024 View all 5 articles

Intracranial Neuromodulation for Pediatric Drug-Resistant Epilepsy: Early Institutional Experience

Provisionally accepted
  • 1 School of Medicine, Stanford University, Stanford, California, United States
  • 2 Touro College of Osteopathic Medicine, Middletown, New York, United States
  • 3 Department of Pediatric Neurology, Stanford University School of Medicine, Stanford, United States
  • 4 Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, California, United States
  • 5 Department of Neurosurgery, Mayo Clinic, Scottsdale, United States
  • 6 Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California, United States
  • 7 Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Palo Alto, United States
  • 8 Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, United States
  • 9 Department of Neurosurgery, School of Medicine, Duke University, Durham, North Carolina, United States
  • 10 Department of Neurosurgery, Stanford University School of Medicine, Stanford, United States
  • 11 Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States

The final, formatted version of the article will be published soon.

    Introduction:Pediatric drug-resistant epilepsy (DRE) is defined as epilepsy that is not controlled by two or more appropriately chosen and dosed anti-seizure medications (ASMs). When alternative therapies or surgical intervention is not viable or efficacious, advanced options like deep brain stimulation (DBS) or responsive neurostimulation (RNS) may be considered. Objective: Describe the Stanford early institutional experience with DBS and RNS in pediatric DRE patients. Methods: Retrospective chart review of seizure characteristics, prior therapies, neurosurgical operative reports, and postoperative outcome data in pediatric DRE patients who underwent DBS or RNS placement. Results: Nine patients had DBS at 16.0±0.9 years and 8 had RNS at 15.3±1.7 years (mean±SE). DBS targets included the centromedian nucleus of the thalamus (78% of DBS patients), anterior nucleus of the thalamus (11%), and pulvinar (11%). RNS placement was guided by stereo-EEG and/or intracranial monitoring in all RNS patients (100%). RNS targets included specific seizure onset zones (63% of RNS patients), bilateral hippocampi (25%) and bilateral temporal lobes (12%). Only DBS patients had prior trials of ketogenic diet (56%) and VNS therapy (67%). Four DBS patients (44%) had prior neurosurgical interventions, including callosotomy (22%) and focal resection (11%). One RNS patient (13%) and one DBS patient (11%) required revision surgery. Two DBS patients (22%) developed postoperative complications. Three RNS patients (38%) underwent additional resections; one RNS patient had electrocorticography recordings for seizure mapping before surgery. For patients with a follow-up of at ≥1 year (n=7 for DBS and n=5 for RNS), all patients had reduced seizure burden. Clinical seizure freedom was achieved in 80% of RNS patients and 20% had a >90% reduction in seizure burden. The majority (71%) of DBS patients had a ≥50% reduction in seizures. No patients experienced no change or worsening of seizure frequency.In the early Stanford experience, DBS was used as a palliatively for generalized or mixed DRE refractory to other resective or modulatory approaches. RNS was used for multifocal DRE with a clear seizure focus on stereo-EEG and no prior surgical interventions. Both modalities reduced seizure burden across all patients. RNS offers the additional benefit of providing data to guide future surgical planning.

    Keywords: Epilepsy, DBS, RNS, pediatric, VNS

    Received: 31 Jan 2025; Accepted: 21 Mar 2025.

    Copyright: © 2025 Uchitel, Lui, Knowles, Parker, Phillips, Halpern, Grant, Buch, Hyslop Segeren and Kumar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Ann Hyslop Segeren, Department of Pediatric Neurology, Stanford University School of Medicine, Stanford, United States
    Kevin K Kumar, Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, 78712, Texas, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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