Authors :
Dominic Nistal, MD – Seattle Children's Hospital
Adriel Barrios-Anderson, MD – Seattle Children's Hospital
Scott Boop, MD – Seattle Children's Hospital
Benjamin Edmonds, MD – Seattle Children's Hospital ,University of Washington
Matthew Recker, MD – Seattle Children's Hospital
Jeffrey Ojemann, MD – Seattle Children's Hospital
Robert Buckley, MD – Seattle Children's Hospital
Jason Hauptman, MD – Phoenix Children's Hospital
Presenting Author: Hannah Goldstein, MD – Seattle Children's Hospital
Rationale:
Non-lesional drug-resistant epilepsy (DRE) in children is difficult to manage, with limited treatment options. Recent advances in deep brain stimulation (DBS) and responsive neurostimulation (RNS) have shown seizure reduction in adults, particularly with thalamic targets for generalized multifocal epilepsy. However, their safety and efficacy remain understudied in the pediatric population. This is the largest pediatric study to date evaluating the safety of thalamic neuromodulation using RNS and DBS in children with non-lesional drug-resistant epilepsy (DRE). This study aims to inform the role of neuromodulation in children with generalized multifocal epilepsy.
Methods:
A retrospective chart review identified pediatric patients with non-lesional DRE who underwent intracranial neuromodulatory treatment (RNS or DBS) targeting thalamic nuclei at Seattle Children’s Hospital from 2020 to present. Surgical and functional outcomes were assessed.
Results:
Twenty-six patients underwent thalamic neuromodulation with DBS (n=12) or RNS (n=14), with a mean age of 14.5 years (range 6–20). Twenty-one had Lennox-Gastaut Syndrome (80.7%) with generalized multifocal epilepsy. Seven patients (33.3%) had prior resective epilepsy surgery, and 21 (80.7%) had prior vagus nerve stimulation (VNS). The centromedian nucleus (CM) was the target in 24 patients; one patient had anterior nucleus of the thalamus (ANT), and one had pulvinar. No serious adverse events occurred. Median hospital stay was 2 days (range 1–13), with median follow-up of 22.0 months (range 1.8–54.1). One patient required explantation for wound infection. Two patients discontinued therapy—one due to ineffectiveness and one due to behavioral changes. Nineteen patients experienced seizure improvement, with a mean reduction of 40.1%.
Conclusions:
Thalamic neuromodulation with RNS or DBS is safe and well tolerated in pediatric patients. This surgical approach offers a promising treatment option for severe, multifocal pediatric epilepsy. Future prospective studies are needed to better understand long-term outcomes and guide device selection and target nucleus choice.
Funding: No funding was received in support of this abstract.