Real-World Preliminary ExperienceWith Responsive Neurostimulation in Pediatric Epilepsy: A Multicenter Retrospective Observational Study

Yasunori Nagahama, Thomas M. Zervos, Kristina K. Murata, Lynette Holman, Torin Karsonovich, Jonathon J. Parker, Jia Shu Chen, H. Westley Phillips, Marytery Fajardo, Hiroki Nariai, Shaun A. Hussain, Brenda E. Porter, Gerald A. Grant, John Ragheb, Shelly Wang, Brent R. O'Neill, Allyson L. Alexander, Robert J. Bollo, Aria Fallah

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BACKGROUND:Despite thewell-documented utility of responsive neurostimulation (RNS, NeuroPace) in adult epilepsy patients, literature on the use of RNS in children is limited. OBJECTIVE: To determine the real-world efficacy and safety of RNS in pediatric epilepsy patients. METHODS: Patients with childhood-onset drug-resistant epilepsy treated with RNS were retrospectively identified at 5pediatric centers. Reduction of disabling seizures and complications were evaluated for children (<18 yr) and young adults (>18 yr) and compared with prior literature pertaining to adult patients. RESULTS: Of 35 patients identified, 17 were <18 yr at the time of RNS implantation, including a 3-yr-old patient. Four patients (11%) had concurrent resection. Three complications, requiring additional surgical interventions, were noted in young adults (2 infections [6%] and 1 lead fracture [3%]). No complicationswere noted in children. Among the 32 patients with continued therapy, 2 (6%) achieved seizure freedom, 4 (13%) achieved ≥90% seizure reduction, 13 (41%) had ≥50% reduction, 8 (25%) had <50% reduction, and 5 (16%) experienced no improvement. The average follow-up duration was 1.7 yr (median 1.8 yr, range 0.3-4.8 yr). There was no statistically significant difference for seizure reduction and complications between children and young adults in our cohort or between our cohort and the adult literature. CONCLUSION: These preliminary data suggest that RNS is well tolerated and an effective off-label surgical treatment of drug-resistant epilepsy in carefully selected pediatric patients as young as 3 yr of age. Data regarding long-term efficacy and safety in children will be critical to optimize patient selection.

Original languageEnglish (US)
Pages (from-to)997-1004
Number of pages8
Issue number6
StatePublished - Dec 1 2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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