Authors :
Walker Taylor, BS – University of Cincinnati College of Medicine
Paul Horn, PhD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Anna Byars, PhD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Daniel Clark, MD PhD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Kishore Vedala, MD – Children's Hospital of Atlanta
Skoch Jesse, MD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Francesco Mangano, DO – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Presenting Author: Hansel Greiner, MD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Rationale:
Responsive neurostimulation (RNS) is an effective treatment for drug-resistant epilepsy, but optimal programming strategies remain undefined in pediatric populations. This study investigates the effect of programming parameter differences on time to >50% seizure reduction. The hypothesis was that there is a minimum charge density which varies based on target (cortical v. thalamic) that results in faster time to seizure reduction.
Methods:
A retrospective chart review of 39 pediatric and young adult epilepsy patients implanted with the RNS system was completed at Cincinnati Children’s Hospital. Minimum followup was 6 months post-implantation. Patients were grouped as following a “gradual” programming strategy if their charge density increased within the thresholds defined as 0.3-0.5 μC/cm2 per visit for cortical leads and 0.1-0.3 μC/cm2 per visit for thalamic lead implants, with no more than two clinical visits outside these ranges prior to the seizure reduction event. The primary outcome was time from implantation to achieving > 50% seizure reduction.Results:
The authors describe a detailed detection and stimulation protocol developed for care of pediatric patients with RNS. The most common etiology was genetic, non-tuberous sclerosis (33%). Within 39 patients (25 cortical and 14 thalamic targets), 33 (84.6%) achieved > 50% seizure reduction and the median time to response was significantly faster in the gradual programming group (3 months) compared to the non-gradual group (26 months, p=0.001). At time of seizure reduction, mean charge for cortical leads was 1.0 μC/cm2; and for thalamic leads 0.65 μC/cm2.
Conclusions:
Gradual, location-specific increases in charge density may play a role in reduced time to seizure reduction in pediatric and young adult patients receiving RNS therapy. Both thalamic and cortical leads were effective across differing seizure etiologies and types. These findings support the use of structured, individualized programming protocols in pediatric epilepsy care.Funding: none