Pediatric neuromodulation for drug-resistant epilepsy: Survey of current practices, techniques, and outcomes across US epilepsy centers

Charuta N. Joshi, Children's Health, University of Texas Southwest, Dallas, Texas, USA.
Cemal Karakas, Department of Neurology, Division of Child Neurology, Norton Neuroscience Institute, University of Louisville, Louisville, Kentucky, USA.
Krista Eschbach, Department of Pediatrics, Children's Hospital Colorado, Section of Neurology, University of Colorado, Aurora, Colorado, USA.
Debopam Samanta, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Kurtis Auguste, Department of Pediatric Neurosurgery, Benioff Children's Hospital, UCSF Weill Institute for Neurosciences, San Francisco, California, USA.
Virendra Desai, Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA.
Rani Singh, Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA.
Patricia McGoldrick, Department of Pediatric Neurology, Maria Fareri Children's Hospital, Valhalla, New York, USA.
Steven Wolf, Department of Pediatric Neurology, Boston Children's Health Physicians, New York Medical Center, Valhalla, New York, USA.
Taylor J. Abel, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Edward Novotny, Department of Neurology and Pediatrics, University of Washington, Seattle, Washington, USA.
Chima Oluigbo, Department of Neurosurgery, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.
Shilpa B. Reddy, Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Allyson Alexander, Department of Pediatrics, Children's Hospital Colorado, Section of Neurology, University of Colorado, Aurora, Colorado, USA.
Angela Price, Division of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA.
Puck Reeders, Department of Neuroscience, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA.
Nancy Mcnamara, Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Erin Fedak Romanowski, Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Ian Mutchnick, Norton Neuroscience Institute, Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
Adam P. Ostendorf, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Ammar Shaikhouni, Department Neurosurgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Andrew Knox, Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA.
Gewalin Aungaroon, Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Joffre Olaya, Division of Neurosurgery, Children's Hospital Orange County, Orange, California, USA.
Carrie R. Muh, Department of Neurosurgery, Maria Fareri Children's Hospital, New York Medical Center, Valhalla, New York, USA.

Document Type

Journal Article

Publication Date

4-1-2024

Journal

Epilepsia open

Volume

9

Issue

2

DOI

10.1002/epi4.12902

Keywords

DBS; RNS; neuromodulation; outcomes; practices

Abstract

Neuromodulation via Responsive Neurostimulation (RNS) or Deep Brain Stimulation (DBS) is an emerging treatment strategy for pediatric drug-resistant epilepsy (DRE). Knowledge gaps exist in patient selection, surgical technique, and perioperative care. Here, we use an expert survey to clarify practices. Thirty-two members of the Pediatric Epilepsy Research Consortium were surveyed using REDCap. Respondents were from 17 pediatric epilepsy centers (missing data in one): Four centers implant RNS only while 13 implant both RNS and DBS. Thirteen RNS programs commenced in or before 2020, and 10 of 12 DBS programs began thereafter. The busiest six centers implant 6-10 new RNS devices per year; all DBS programs implant <5 annually. The youngest RNS patient was 3 years old. Most centers (11/12) utilize MP2RAGE and/or FGATIR sequences for planning. Centromedian thalamic nuclei were the unanimous target for Lennox-Gastaut syndrome. Surgeon exposure to neuromodulation occurred mostly in clinical practice (14/17). Clinically significant hemorrhage (n = 2) or infection (n = 3) were rare. Meaningful seizure reduction (>50%) was reported by 81% (13/16) of centers. RNS and DBS are rapidly evolving treatment modalities for safe and effective treatment of pediatric DRE. There is increasing interest in multicenter collaboration to gain knowledge and facilitate dialogue. PLAIN LANGUAGE SUMMARY: We surveyed 32 pediatric epilepsy centers in USA to highlight current practices of intracranial neuromodulation. Of the 17 that replied, we found that most centers are implanting thalamic targets in pediatric drug-resistant epilepsy using the RNS device. DBS device is starting to be used in pediatric epilepsy, especially after 2020. Different strategies for target identification are enumerated. This study serves as a starting point for future collaborative research.

Department

Neurological Surgery

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