Larrew Thomas, Greiner Hansel M, Arya Ravindra, Tenney Jeffrey R, Aungaroon Gewalin, Clark Daniel J, Vedala Kishore, Drake Austin W, Leach James L, Horn Paul S, Skoch Jesse, Mangano Francesco T
Division of Pediatric Neurosurgery, Riley Hospital for Children at IU Health, Indianapolis, Indiana, USA.
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Neurosurgery. 2025 Jun 20. doi: 10.1227/neu.0000000000003583.
Epilepsy is a significant cause of morbidity and has negative effects on cognitive and psychosocial development in pediatric and young adult patients. For pediatric patients who have epileptogenic foci that are poorly localized, deep, bilateral, or in eloquent regions and are not candidates for resection, responsive neurostimulation (RNS) may be an option. The study objective was to demonstrate safety and seizure outcomes from RNS in pediatric and young adults with intractable epilepsy with a specific focus on differences between thalamic and nonthalamic RNS lead implantation.
The authors describe a single institution's experience with RNS in patients with drug-resistant epilepsy who were not candidates for seizure focus resection. An Institutional Review Board-approved retrospective review was conducted of all pediatric and young adult patients who underwent RNS implantation at Cincinnati Children's Hospital Medical Center between 2019 and 2023.
In total, 24 patients met the inclusion criteria for the study. Seven had thalamic targets whereas 17 had nonthalamic targets. The mean patient age at the time of surgery was 13.8 years (range 5-30), with a mean follow-up of 13 months. Thirteen patients (54%) had prior surgery for seizure control. The median global seizure percentage reduction was 68% in the nonthalamic group and 80% in the thalamic group, a nonsignificant difference, resulting in a reduction of 74% for all study patients (P = .816). Two adverse events (8.3%) included a wound infection and a lead repositioning.
RNS implantation in pediatric and young adult patients with epilepsy seems to be a safe and efficacious modality for lowering seizure burden in cases where resection of epileptogenic foci is not a viable option. Thalamic and nonthalamic RNS targeting both lead to impactful seizure reduction. This study adds to the growing body of evidence suggesting that RNS is appropriate in pediatric and young adult patients.
癫痫是发病的重要原因，对儿童及青年患者的认知和心理社会发展有负面影响。对于致痫灶定位不佳、位置较深、双侧存在或位于功能区且不适合进行切除手术的儿童患者，反应性神经刺激（RNS）可能是一种选择。本研究的目的是证明RNS在患有难治性癫痫的儿童和青年成人中的安全性和癫痫发作结果，特别关注丘脑和非丘脑RNS导联植入之间的差异。
作者描述了单一机构在不适合进行癫痫病灶切除的耐药性癫痫患者中使用RNS的经验。对2019年至2023年期间在辛辛那提儿童医院医疗中心接受RNS植入的所有儿童和青年成人患者进行了一项经机构审查委员会批准的回顾性研究。
共有24例患者符合该研究的纳入标准。7例患者的靶点在丘脑，17例患者的靶点在非丘脑。手术时患者的平均年龄为13.8岁（范围5 - 30岁），平均随访时间为13个月。13例患者（54%）曾接受过控制癫痫发作的手术。非丘脑组癫痫发作总体减少百分比的中位数为68%，丘脑组为80%，差异无统计学意义，所有研究患者的癫痫发作减少率为74%（P = 0.816）。发生了两例不良事件（8.3%），包括伤口感染和导联重新定位。
对于癫痫病灶切除不可行的儿童及青年成人患者，植入RNS似乎是一种安全有效的减轻癫痫发作负担的方式。针对丘脑和非丘脑的RNS均能有效减少癫痫发作。本研究增加了越来越多的证据，表明RNS适用于儿童和青年成人患者。
