Abstract

BACKGROUND

Despite the well-documented utility of responsive neurostimulation (RNS, NeuroPace) in adult epilepsy patients, literature on the use of RNS in children is limited.

OBJECTIVE

To determine the real-world efficacy and safety of RNS in pediatric epilepsy patients.

METHODS

Patients with childhood-onset drug-resistant epilepsy treated with RNS were retrospectively identified at 5 pediatric centers. Reduction of disabling seizures and complications were evaluated for children (<18 yr) and young adults (>18 yr) and compared with prior literature pertaining to adult patients.

RESULTS

Of 35 patients identified, 17 were <18 yr at the time of RNS implantation, including a 3-yr-old patient. Four patients (11%) had concurrent resection. Three complications, requiring additional surgical interventions, were noted in young adults (2 infections [6%] and 1 lead fracture [3%]). No complications were noted in children. Among the 32 patients with continued therapy, 2 (6%) achieved seizure freedom, 4 (13%) achieved ≥90% seizure reduction, 13 (41%) had ≥50% reduction, 8 (25%) had <50% reduction, and 5 (16%) experienced no improvement. The average follow-up duration was 1.7 yr (median 1.8 yr, range 0.3-4.8 yr). There was no statistically significant difference for seizure reduction and complications between children and young adults in our cohort or between our cohort and the adult literature.

CONCLUSION

These preliminary data suggest that RNS is well tolerated and an effective off-label surgical treatment of drug-resistant epilepsy in carefully selected pediatric patients as young as 3 yr of age. Data regarding long-term efficacy and safety in children will be critical to optimize patient selection.

中文翻译：

---

小儿癫痫反应性神经刺激的真实初步经验：一项多中心回顾性观察研究

摘要

背景

尽管响应性神经刺激（RNS，NeuroPace）在成人癫痫患者中的效用已得到充分证明，但关于在儿童中使用 RNS 的文献是有限的。

客观的

确定 RNS 在小儿癫痫患者中的真实疗效和安全性。

方法

在 5 个儿科中心回顾性地确定了接受 RNS 治疗的儿童期耐药性癫痫患者。评估了儿童（<18 岁）和年轻成人（>18 岁）致残性癫痫发作和并发症的减少情况，并与之前有关成人患者的文献进行了比较。

结果

在确定的 35 名患者中，17 名在 RNS 植入时年龄小于 18 岁，其中包括一名 3 岁的患者。四名患者（11%）同时切除。在年轻人中发现了三种需要额外手术干预的并发症（2 例感染 [6%] 和 1 例导线断裂 [3%]）。儿童未发现并发症。在 32 名继续治疗的患者中，2 名 (6%) 达到无癫痫发作，4 名 (13%) 达到 ≥90% 的癫痫发作减少，13 名 (41%) 的癫痫发作减少 ≥50%，8 名 (25%) 的癫痫发作减少 <50% , 和 5 (16%) 没有改善。平均随访时间为 1.7 年（中位数 1.8 年，范围 0.3-4.8 年）。在我们的队列中或我们的队列与成人文献之间，儿童和年轻人的癫痫发作减少和并发症没有统计学上的显着差异。

结论

这些初步数据表明，RNS 耐受性良好，并且在精心挑选的 3 岁儿童患者中对耐药性癫痫进行了有效的超说明书手术治疗。有关儿童长期疗效和安全性的数据对于优化患者选择至关重要。