Authors :
Presenting Author: Nunthasiri Wittayanakorn, MD – Children's National Hospital, George Washington University
Cemal Karakas, MD – University of Louisville
Krista Eschbach, MD – Children Hospital Colorado
Benjamin Edmonds, MD – Seattle Children's Hospital ,University of Washington
Shilpa Reddy, MD – Vanderbilt University
Pradeep Javarayee, MD MBA – The Medical College of Wisconsin, Milwaukee
Adam Ostendorf, MD – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Ammar Shaikhouni, MD, PhD – Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Danilo Bernardo, MD – University of California at San Francisco
Ernesto Gonzalez-Giraldo, MD – University of California at San Francisco
Kurtis Auguste, MD – University of California at San Francisco
Edward Novotny, MD – Seattle Children’s Hospital
Angela Price, MD – Children's Medical Center Dallas, UTSW
Pilar Pichon, MD – Children's Hospital of Orange County
Maija Steenari, MD – Childrens Hospital of Orange County, CA
M. Scott Perry, MD – Cook Children’s Physician Network
Ahmad Marashly, MD – Johns Hopkins University
Chima Oluigbo, MD – Children's National Hospital, George Washington University
Ian Mutchnick, MD, MS – Norton Neuroscience Institute
Charuta Joshi, MBBS, MSCS, FAES, CSCN – Childrens Medical Center Dallas, UTSW
Rationale:
Rationale: To conduct an interim analysis of outcomes of thalamic neuromodulation in pediatric drug-resistant epilepsy(DRE).
Methods:
Methods: We performed a retrospective analysis of prospectively collected data from patients enrolled in a multicenter pediatric epilepsy surgery database. Data were abstracted from all patients that had only thalamic neuromodulationimplants (variable nuclei, responsive neurostimulation [RNS] or deep brain stimulation [DBS] placement). Patients with corticothalamic neuromodulation were excluded.
Results:
Results: Eleven NAEC Level 4 pediatric epilepsy centers across the United States contributed to this data. Data from 131 patients [78 male; 99 White] were analyzed. The median age at the time of surgery was 15.9 years (IQR 10.8-17.9 years).Procedures included RNS (n=87), and DBS (n=23); 5 each had DBS and RNS respectively following vagus nerve stimulation (VNS); Previous therapies included resective surgery (n=2); corpus callosotomy (n=4); dietary therapy(n=11); dietary exposure combined with other palliative measures like VNS or corpus callosotomy (n=16). The thalamicneuromodulation target was centromedian nucleus (CMN) in 110 patients, anterior nucleus of thalamus (ANT) in 14, pulvinar nucleus in 5, pulvinar and CMN in 1, and pulvinar and ANT in 1. Of the 117 patients with a median follow-up duration of 12 months (IQR 6-23.8 months) and reported seizure outcomes at last visit, 60 [46%] achieved greater than 50% seizure reduction. Eleven (9%) patients achieved seizure freedom. Clinician assessment of improvement (a combination of seizure outcome, behavioral outcome, antiseizure medication [ASM] changes, and hospitalizations using a Likert scale) indicated a slightly greater number of patients were minimally improved or better while on a median of 4 ASMs at last visit (N = 71 and 58 respectively). There was no difference in seizure outcomes based on the type of neuromodulation device, implanted thalamic nuclei, degree of developmental delay, or classification of epilepsy syndromes.
Conclusions:
Conclusion: Thalamic neuromodulation is an effective option for treating pediatric DRE irrespective of type of epilepsysyndrome. DBS and RNS appear to be equally effective, and the thalamic nucleus chosen for neuromodulation does not seem to impact seizure control outcomes in this initial interim analysis.
Funding: N/A