Responsive neurostimulation for treatment of pediatric refractory epilepsy: A pooled analysis of the literature

Adam S Levy; Lauren L Bystrom; Erik C Brown; Marytery Fajardo; Shelly Wang

doi:10.1016/j.clineuro.2023.108012

Responsive neurostimulation for treatment of pediatric refractory epilepsy: A pooled analysis of the literature

Clin Neurol Neurosurg. 2023 Nov:234:108012. doi: 10.1016/j.clineuro.2023.108012. Epub 2023 Oct 11.

Authors

Adam S Levy¹, Lauren L Bystrom², Erik C Brown², Marytery Fajardo³, Shelly Wang⁴

Affiliations

¹ Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA. Electronic address: adam.levy@med.miami.edu.
² Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
³ Division of Neurology, Brain Institute, Nicklaus Children's Hospital, 3200 SW 60th Ct Ste 302, Miami, FL, 33155, USA.
⁴ Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA; Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, 3200 SW 60th Ct Ste 302, Miami, FL, 33155, USA.

PMID: 37839147
DOI: 10.1016/j.clineuro.2023.108012

Abstract

Background: Drug-resistant epilepsy (DRE) is a complex medical condition often requiring resective surgery and/or some form of neurostimulation. In recent years responsive neurostimulation (RNS) has shown promising results in adult DRE, however there is a paucity of information regarding outcomes of RNS among pediatric patients treated with DRE. In this individual patient data meta-analysis (IPDMA) we seek to elucidate the effects RNS has on the pediatric population.

Methods: Literature regarding management of pediatric DRE via RNS was reviewed in accordance with individual patient data meta-analysis guidelines. Four databases were searched with keywords ((Responsive neurostimulation) AND (epilepsy)) through December of 2022. From 1624 retrieved full text studies, 15 were ultimately included affording a pool of 98 individual participants.

Results: The median age at implantation was 14 years (n = 95) with 42% of patients having undergone prior resective epilepsy surgery, 18% with prior vagus nerve stimulation (VNS), and 1% with prior RNS. At a median follow up time 12 months, median percent seizure reduction was 75% with 57% of patients achieving Engel Class < 2 outcome, 9.7% of which achieved seizure freedom. We report a postoperative complication rate of 8.4%, half of which were device-related infections. Magnetic resonance imaging (MRI)-negative cases were negatively associated with magnitude of seizure reduction, and direct targeting techniques were associated with stronger treatment response when compared to other methods.

Conclusions: This review suggests RNS to be an effective treatment modality for pediatric patients with a postoperative complication rate comparable to that of RNS in adults. Investigation of prognostic clinical variables should be undertaken to augment patient selection. Last, multi-institutional prospective study of long-term effects of RNS on pediatric patients would stand to benefit clinicians in the management of pediatric DRE.

Keywords: Epilepsy; Neuromodulation; Neuropace; Neurostimulation; Pediatric; RNS.

Publication types

Meta-Analysis
Review

MeSH terms

Adolescent
Adult
Child
Deep Brain Stimulation* / methods
Drug Resistant Epilepsy* / therapy
Epilepsy* / therapy
Humans
Postoperative Complications / therapy
Prospective Studies
Seizures / therapy
Treatment Outcome