Abstracts

Role of Thalamic stereo-EEG in Pediatric Drug-Resistant Epilepsy: A multicenter analysis from Pediatric Epilepsy Research Consortium (PERC) Neuromodulation Database

Abstract number : 3.288
Submission category : 4. Clinical Epilepsy / 4C. Clinical Treatments
Year : 2025
Submission ID : 840
Source : www.aesnet.org
Presentation date : 12/8/2025 12:00:00 AM
Published date :

Authors :
Presenting Author: Charuta Joshi, MBBS, MSCS, FAES, CSCN – Childrens Medical Center Dallas, UTSW

Andrew Knox, MD – University of Wisconsin-Madison
Cemal Karakas, MD, FACNS – Norton Children's Neuroscience Institute
Benjamin Edmonds, MD – Seattle Children's Hospital ,University of Washington
Nunthasiri Wittayanakorn, MD – Children's National Hospital, George Washington University
Ammar Shaikhouni, MD, PhD – Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Debopam Samanta, MD – University of Arkansas
Maija Steenari, MD – Childrens Hospital of Orange County, CA
Angela Price, MD – Children's Medical Center Dallas, UTSW
Neggy Rismanchi, MD, Ph.D. – UC Davis Health, UC Davis
Steven Wolf, MD – Boston Children's Health Physicians; Westchester Medical Center Health Network
Patricia McGoldrick, NP – New York Medical College
Sean Lew, MD – Children's Wisconsin, Medical College of Wisconsin
Taylor Abel, MD – Children's Hospital of Pittsburgh, UPMC
Chima Oluigbo, MD – Children's National Hospital, George Washington University

Rationale: While thalamic involvement in seizure networks is increasingly recognized, there is limited data on the specific clinical purposes of thalamic stereo-EEG (sEEG), its contribution to timely seizure onset detection, and its impact on surgical planning in pediatric drug-resistant epilepsy (DRE). We aimed to perform an interim analysis of outcomes of thalamic-sEEG in pediatric DRE

Methods: We conducted a retrospective analysis of prospectively collected data from patients who underwent thalamic sEEG monitoring. We defined seizure onset as “early” thalamic onset (involvement of thalamic nuclei within 3 seconds of sEEG onset) and “late” (involvement of thalamic nuclei after 3 seconds of sEEG onset). Associations between various factors contributing to “early” versus “late” thalamic onset were examined using Chi-square test with two-sided p-value of 0.05

Results: The analysis included 106 patients (M:F-53:53) followed at 12 NAEC level-4 pediatric epilepsy centers. The median age at sEEG was 16 years [SD:4.74; IQR:11–18] and the median duration of epilepsy prior to sEEG was 7 years [SD:5.0; range:4–12]. Main etiological groups were structural in 49 [45.8%] and unknown in 43 [40%]. Seventeen [16%] patients had Lennox-Gastaut syndrome [LGS] and 19 [18%] patients underwent previous vagus nerve stimulation. Epilepsy type was multifocal in 69 [64.5%] patients, focal in 24 [22.4%] and generalized in 12 [11.2%]. SEEG electrode placement was bilateral in 77 [72%] patients. Fifty-seven [53.2%] patients had an abnormal MRI. The goal of sEEG was to study thalamic involvement in 89 patients [90%] or to study network in 103 [96%]. There was a median of 2 electrode contacts [SD:1.5; range:2–4] in the thalamus. MP2RAGE was the most frequent [n= 86; 80.4%] MRI sequence used. Robotic assistance was used in most patients [n=99; 92.5%]. Factors associated with early thalamic onset included a diagnosis of LGS [p=0.03]; multifocal epilepsy with broad implantation to study network [p=0.04], and bilateral CM or pulvinar targeting [p=0.002 and p=0.01 respectively]. Outcomes at 12 months were available in 38 [35.8%] patients. Thalamic targets were chosen for neuromodulation in 51 [48%] patients and included the anterior nucleus of thalamus [ANT] in 41 [30%], centromedian nucleus [CM] in 79 [74%] and pulvinar in 34 [32%]. There was no statistically significant association of 12-month seizure improvement ( > 50%) in patients that had early thalamic onset

Conclusions: Early thalamic onset was demonstrated in two thirds of the patient that underwent sEEG and guided ultimate surgical decision making such that thalamic target was chosen for neuromodulation in 48% of our patients while directing other treatment decisions.

Funding: No funding

Clinical Epilepsy