Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
National Kapodistrian University of Athens Medical School, Athens, Greece.
Epilepsy Behav. 2022 Apr;129:108646. doi: 10.1016/j.yebeh.2022.108646. Epub 2022 Mar 14.
Responsive neurostimulation (RNS) is a novel technology for drug-resistant epilepsy rising from bilateral hemispheres or eloquent cortex. Although recently approved for adults, its safety and efficacy for pediatric patients is under investigation.
A comprehensive literature search (Pubmed/Medline, Scopus, Cochrane) was conducted for studies on RNS for pediatric epilepsy (<18 y/o) and supplemented by our institutional series (4 cases). Reduction in seizure frequency at last follow-up compared to preoperative baseline comprised the primary endpoint.
A total of 8 studies (49 patients) were analyzed. Median age at implant was 15 years (interquartile range [IQR] 12-17) and 63% were males. A lesional MRI was noted in 64% (14/22). Prior invasive EEG recording was performed in the majority of patients (90%) and the most common modality was stereoelectroencephalography (57%). The most common implant location (total of 94 RNS leads) was the frontal lobe (27%), followed by mesial temporal structures (23%) and thalamus (17%). At a median follow-up of 22 months, median seizure frequency reduction was 75% (IQR: 50-88%) and 80% were responders (>50% seizure reduction). Responses ranged from 50% for temporal lobe epilepsy to 81-93% for frontal, parietal, and multilobar epilepsy. Four infections were observed (8%) and there were no hematomas or postoperative neurological deficits.
Current evidence, albeit limited by potential publication bias, supports the promising safety and efficacy profile of RNS for medically refractory pediatric epilepsy. Randomized controlled trial data are needed to further establish the role of this intervention in preoperative discussions with patients and their families.
反应性神经刺激（RNS）是一种新兴的技术，适用于双侧半球或功能区的耐药性癫痫。虽然最近已批准用于成人，但仍在研究其对儿科患者的安全性和有效性。
对 RNS 治疗儿科癫痫（<18 岁）的研究进行了全面的文献检索（Pubmed/Medline、Scopus、Cochrane），并补充了我们机构的系列研究（4 例）。主要终点是与术前基线相比，最后一次随访时的癫痫发作频率降低。
共分析了 8 项研究（49 例患者）。植入时的中位年龄为 15 岁（四分位距 [IQR] 12-17），63%为男性。64%（14/22）的患者有病变性 MRI。大多数患者（90%）都进行了侵入性 EEG 记录，最常见的方式是立体脑电图（57%）。最常见的植入部位（总共 94 个 RNS 导联）是额叶（27%），其次是内侧颞叶结构（23%）和丘脑（17%）。在中位数为 22 个月的随访中，癫痫发作频率中位数降低了 75%（IQR：50-88%），80%的患者为应答者（癫痫发作减少>50%）。应答范围从颞叶癫痫的 50%到额叶、顶叶和多灶性癫痫的 81-93%。观察到 4 例感染（8%），无血肿或术后神经功能缺损。
尽管受到潜在发表偏倚的限制，目前的证据仍支持 RNS 治疗药物难治性儿科癫痫的良好安全性和有效性。需要随机对照试验数据来进一步确定该干预措施在与患者及其家属进行术前讨论中的作用。
