Pediatric epilepsy is characterized as drug resistant in 20%–30% of patients and defined as persistent seizures despite adequate treatment with two first-line antiepileptic medications. The American Academy of Neurology advocates surgical options earlier in the treatment of epilepsy to provide long-term seizure reduction. The new development of minimally invasive approaches has recently allowed for surgical options to patients not previously deemed surgical candidates. These may include patients with bilateral, deep, eloquent, or poorly localizing epileptogenic foci. To this end, responsive neurostimulation (RNS) is an FDA-approved closed-loop neuromodulation device for adjuvant treatment of adults with medically intractable epilepsy arising from one or multiple foci.

In this study, the authors describe their initial institutional experience with the use of RNS in pediatric patients with drug-resistant epilepsy. An IRB-approved retrospective review was conducted of 8 pediatric patients who underwent RNS implantation at Cincinnati Children’s Hospital Medical Center between 2019 and 2021.

Eight patients met the inclusion criteria for the study. The average age at the time of surgery was 14.7 years (range 8–18 years) with a mean follow-up of 16.5 months. All patients underwent invasive monitoring with stereo-EEG, subdural grid placement, or a combination of both. All patients had either bilateral or eloquent cortex targets. Trajectories were based on noninvasive (phase 1) and invasive (phase 2) seizure onset zone localization data. Four (50%) of the 8 patients underwent surgical intervention for epilepsy prior to RNS placement. RNS electrodes were placed with robot-assisted guidance in a hybrid operating room with intraoperative CT and electrocorticography. The authors demonstrated individualized RNS electrode trajectory and placement with targets in the amygdala/hippocampus, bilateral insula, bilateral parietal and occipital targets, and frontoparietal regions for a total of 14 implanted electrodes. One adverse event occurred, a wound infection requiring return to the operating room for removal of the RNS implant. All patients demonstrated a reduction in seizure frequency. All patients achieved > 50% reduction in seizure frequency at last follow-up.

RNS implantation in carefully selected pediatric patients appears safe and efficacious in reducing seizure burden with a low rate of operative complications.

小儿癫痫的特点是 20%–30% 的患者存在耐药性，定义为尽管使用两种一线抗癫痫药物进行了充分治疗，但仍持续发作。美国神经病学学会提倡在癫痫治疗早期进行手术选择，以长期减少癫痫发作。微创方法的新发展最近允许对以前不被认为是手术候选人的患者进行手术选择。这些可能包括双侧、深部、口才或定位不佳的致痫灶的患者。为此，反应性神经刺激 (RNS) 是 FDA 批准的闭环神经调节装置，用于辅助治疗由一个或多个病灶引起的医学上难治性癫痫的成人。

在这项研究中，作者描述了他们在儿童耐药性癫痫患者中使用 RNS 的初步机构经验。对 2019 年至 2021 年间在辛辛那提儿童医院医疗中心接受 RNS 植入的 8 名儿科患者进行了 IRB 批准的回顾性审查。

八名患者符合该研究的纳入标准。手术时的平均年龄为 14.7 岁（范围 8-18 岁），平均随访时间为 16.5 个月。所有患者都接受了立体脑电图、硬膜下网格放置或两者结合的侵入性监测。所有患者都有双侧或雄辩的皮质目标。轨迹基于非侵入性（第 1 阶段）和侵入性（第 2 阶段）癫痫发作起始区定位数据。8 名患者中有 4 名 (50%) 在放置 RNS 之前接受了癫痫手术干预。RNS 电极在机器人辅助引导下放置在具有术中 CT 和皮层电图的混合手术室中。作者展示了个性化的 RNS 电极轨迹和目标在杏仁核/海马、双侧岛叶、双侧顶叶和枕骨靶区，以及额顶区共 14 个植入电极。发生了一个不良事件，伤口感染需要返回手术室取出 RNS 植入物。所有患者均表现出癫痫发作频率降低。在最后一次随访中，所有患者的癫痫发作频率均降低了 50% 以上。

在精心挑选的儿科患者中植入 RNS 在减轻癫痫发作负担方面似乎是安全有效的，且手术并发症发生率低。