Responsive neurostimulation (RNS) of thalamic nuclei in pediatric drug-resistant epilepsy (DRE)
Abstract number :
2.401
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2021
Submission ID :
1886509
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Deepankar Mohanty, MD - Baylor College of Medicine; Kimberly Houck, MD - Pediatric Neurology - Baylor College of Medicine; James Riviello, MD - Pediatric Neurology - Baylor College of Medicine; Daniel Curry, MD - Pediatric Neurosurgery - Baylor College of Medicine; Irfan Ali, MD - Pediatric Neurology - Baylor College of Medicine
Rationale: Responsive neurostimulation (RNS) is an FDA-approved and effective form of neuromodulation to treat patients with drug-resistant epilepsy (DRE) who are ineligible or refractory to surgical treatment1,2. The cerebral cortex has reciprocal connections with the thalamic nuclei, and hence the epileptic networks can be modified through cortico-thalamic pathways. The individuals with regional epilepsy, multiple foci in a lobe, or non-localizable DRE, may also benefit from neuromodulation using the RNS System. Recent literature has shown seizure reduction in two patients with Lennox-Gastaut syndrome (LGS) 3 and idiopathic epilepsy with an application of RNS to the centromedian nucleus of the thalamus4. The purpose of this study is to review the outcomes of RNS application to thalamic nuclei for pediatric epilepsy patients at Texas Children’s Hospital.
Methods: We reviewed charts of all pediatric patients (ages 6-22) who had RNS devices implanted at Texas Children’s Hospital between July 2016 and March 2021, with electro-clinical seizures and at least one stimulating electrode in the thalamus. The seizure reduction was calculated by a change in clinical seizure frequency as reported by the patient-caregiver between pre-implantation baseline and the most recent follow-up visit. Quality of life (QOL) change was reported subjectively by the caregiver at each post-implantation follow-up.
Results: 11/47 (23.4%) patients had active depth electrodes implanted in one of the thalamic nuclei during the period specified. Nine (82%) patients had unilateral, and two (18.2%) had bilateral thalamic stimulation. Six (54.5%) had more than six months of follow-up (range 8-17 months). Maximum stimulation charge density ranged from 0.5 to 2 µC/cm2. One patient became seizure-free. Seizure reduction was 95-99% in one, 60-70% in two, while two reported no change. 3/6 (50%) also reported improvements in QOL, whereas others reported either no change or worsening.
Conclusions: Responsive neurostimulation targeting thalamic nuclei shows promise to reduce seizure burden in pediatric patients with regional or non-localizable DRE. Further studies with larger patient cohorts and longer follow-up times are required to fully evaluate the factors contributing to outcomes of thalamic RNS.
Funding: Please list any funding that was received in support of this abstract.: None.
Neurophysiology