• Yasunori Nagahama, Thomas M Zervos, Kristina K Murata, Lynette Holman, Torin Karsonovich, Jonathon J Parker, Jia-Shu Chen, H Westley Phillips, Marytery Fajardo, Hiroki Nariai, Shaun A Hussain, Brenda E Porter, Gerald A Grant, John Ragheb, Shelly Wang, Brent R O'Neill, Allyson L Alexander, Robert J Bollo, and Aria Fallah.
• Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA.
• Neurosurgery. 2021 Nov 18; 89 (6): 997-1004.

BackgroundDespite the well-documented utility of responsive neurostimulation (RNS, NeuroPace) in adult epilepsy patients, literature on the use of RNS in children is limited.ObjectiveTo determine the real-world efficacy and safety of RNS in pediatric epilepsy patients.MethodsPatients 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.ResultsOf 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.ConclusionThese 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.© Congress of Neurological Surgeons 2021.

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