Safety of responsive neurostimulation in drug-resistant pediatric epilepsy patients at the University of Pittsburgh
Abstract number :
2.419
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1886461
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Kendall Curtis, BS - Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; Jasmine Hect, BSc – MD-PhD Student (G1), Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; Emily Harford, BA, MA – Clinical Research Coordinator, Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; William Welch, MD – Assistant Professor of Pediatrics, Child Neurology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; Taylor Abel, MD, FAANS – Assistant Professor of Neurological Surgery and Bioengineering, Neurological Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center
Rationale: Responsive neurostimulation (RNS) is a promising treatment for drug-resistant pediatric focal, multifocal, and generalized epilepsies. RNS for focal epilepsy offers an alternative to resection or ablation of seizure foci involving eloquent cortex.1 Preliminary evidence has demonstrated safety in children with drug-resistant epilepsy (DRE).2
1. Yan H, Ibrahim GM. (2019) Resective epilepsy surgery involving eloquent cortex in the age of responsive neurostimulation: A value-based decision-making framework. Epilepsy Behav. 99:106479.
2. Yasunori Nagahama, MD, Thomas M Zervos, MD, Kristina K Murata, MSN, FNP-BC... et al. (2021) Real-World Preliminary Experience with Responsive Neurostimulation in Pediatric Epilepsy: A Multicenter Retrospective Observational Study, Neurosurgery.
Methods: We present a case series of 11 pediatric RNS cases, ages 9-21 (mean 14.5 +/- 3.9 years), including depth electrode (n=9), strip electrode (n=1), or both (n=1), performed at our institution between 2020-2021. Data was collected retrospectively and assessed RNS safety and effectiveness in reducing seizure frequency. Infection, stroke, hemorrhage, and device malfunction were considered complications. Engel classification was used to define post-operative seizure responsiveness to RNS.
Results: Two cases underwent depth electrode implantation to bilateral centromedian nuclei, three cases to motor cortex, three cases to bilateral medial temporal lobe, and three cases to cortical seizure foci. One (9%) patient developed a postoperative infection, which was treated with wound irrigation and debridement without hardware removal and prolonged antibiotics. One case (9%) developed pseudomeningocele at the electrode insertion site, which resolved without intervention. Three cases (27%) experienced transient post-operative neurologic symptoms, including two with post-operative lower extremity weakness, and another who experienced left arm weakness following activation of the RNS device. Lower extremity weakness resolved spontaneously prior to discharge and the stimulation-related weakness improved following adjustment of parameters. Of the 8 patients with at least two follow-up visits following RNS activation (mean 8.9 +/- 3.8 months post-operative), three (38%) were Engel Class II, two (25%) were Engel Class III, and three (38%) were Engel Class IV).
Conclusions: We found 63% of patients experienced at least a 50% decrease in seizure frequency at longest follow-up. 18% experienced postoperative complications of some kind and only one patient required reoperation for infection. Our findings support RNS as a safe treatment for DRE in pediatric patients consistent with previous studies. Given the short length of follow-up in our series, we expect rates of seizure frequency reduction to increase over time.
Funding: Please list any funding that was received in support of this abstract.: This research was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number T32GM008208. Dr. Abel reports funding from awards R21 DC019217-01A1 and R01 DC013315-07. Jasmine Hect reports funding from T32GM008208. The content is responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Surgery