1Department of Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix; and.
2University of Arizona College of Medicine, Phoenix, Arizona.
Neurosurg Focus. 2022 Oct;53(4):E9. doi: 10.3171/2022.7.FOCUS22339.
Medically refractory epilepsy remains a therapeutic challenge when resective surgery is not a practical option and indirect neurostimulation efficacy may be limited. In these instances responsive neurostimulation (RNS) has been used in adults, with good outcomes in most patients. However, the utility of RNS in children and young adults has not been systematically explored. In this study, the authors present a single institution's experience with RNS in pediatric patients.
A single-center retrospective chart review of patients who underwent RNS implantation at Phoenix Children's Hospital during the 4-year period between January 2018 and December 2021 was performed.
Following evaluation for epilepsy surgery, 22 patients underwent RNS implantation using different anatomical targets depending on the predetermined epileptic focus/network. In the cohort, 59% of patients were male, the mean age at implantation was 16.4 years (range 6-22 years), and the mean follow-up time was 2.7 years (range 1.0-4.3 years). All patients had a preoperative noninvasive evaluation that included MRI, video-electroencephalography, and resting-state functional MRI. Additionally, 13 patients underwent invasive monitoring with stereo-electroencephalography to help determine RNS targets. All patients had variable positive responses with reduction of seizure frequency and/or intensity. Overall, seizure frequency reduction of > 50% was seen in the majority (86%) of patients. There were two complications: one patient experienced transitory weakness and one generator failed, requiring replacement. A patient died of sudden unexpected death in epilepsy 3 years after implantation despite being seizure free during the previous year.
RNS used in children with medically refractory epilepsy improved seizure control after implantation, with decreases in seizure frequency > 50% from preoperative baseline in the majority of patients. Preliminary findings indicate that functional MRI and stereo-electroencephalography were helpful for RNS targeting and that RNS can be used safely even in young children.
当手术切除不是一种可行的选择，且间接神经刺激的疗效可能有限时，药物难治性癫痫仍然是一个治疗挑战。在这些情况下，反应性神经刺激（RNS）已被用于成人，大多数患者的结果良好。然而，RNS 在儿童和青少年中的应用尚未得到系统的探索。在本研究中，作者报告了单机构在儿科患者中使用 RNS 的经验。
对 2018 年 1 月至 2021 年 12 月期间在凤凰城儿童医院接受 RNS 植入术的患者进行了单中心回顾性图表审查。
在对癫痫手术进行评估后，根据预定的癫痫灶/网络，22 名患者使用不同的解剖目标进行了 RNS 植入。在该队列中，59%的患者为男性，植入时的平均年龄为 16.4 岁（范围 6-22 岁），平均随访时间为 2.7 年（范围 1.0-4.3 年）。所有患者均接受了术前非侵入性评估，包括 MRI、视频脑电图和静息态功能 MRI。此外，13 名患者接受了立体脑电图侵入性监测，以帮助确定 RNS 靶点。所有患者的癫痫发作频率和/或强度均有不同程度的阳性反应。总体而言，大多数（86%）患者的癫痫发作频率降低了>50%。有两个并发症：一名患者出现短暂性无力，一名患者的发生器发生故障，需要更换。一名患者在植入后 3 年因癫痫猝死，尽管在前一年无癫痫发作。
RNS 用于药物难治性癫痫的儿童，在植入后改善了癫痫控制，大多数患者的癫痫发作频率比术前基线降低了>50%。初步研究结果表明，功能 MRI 和立体脑电图对 RNS 靶向治疗有帮助，即使是在幼儿中，RNS 也可以安全使用。
