Pediatric neuromodulation for drug-resistant epilepsy: Survey of current practices, techniques, and outcomes across US epilepsy centers
Epilepsia Open: Volume 9, Issue 2
AUTHORS
Charuta N Joshi 1 , Cemal Karakas 2 , Krista Eschbach 3 , Debopam Samanta 4 , Kurtis Auguste 5 , Virendra Desai 6 , Rani Singh 7 , Patricia McGoldrick 8 , Steven Wolf 9 , Taylor J Abel 10 11 , Edward Novotny 12 13 , Chima Oluigbo 14 , Shilpa B Reddy 15 , Allyson Alexander 3 16 , Angela Price 17 , Puck Reeders 18 , Nancy Mcnamara 19 , Erin Fedak Romanowski 19 , Ian Mutchnick 20 , Adam P Ostendorf 21 , Ammar Shaikhouni 22 , Andrew Knox 23 , Gewalin Aungaroon 24 , Joffre Olaya 25 , Carrie R Muh 26
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.