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Objective <p>The aim of this study is to delineate technical considerations for subcortical electrode targeting in children with DRE and to present a target selection decision-support tool for pediatric neurosurgeons for DBS and RNS.</p> Methods <p>A systematic review of studies through age ≤ 19&#xa0;years reporting DBS or RNS implantation for DRE was performed. Articles were screened for details on trajectory planning, imaging parameters, intraoperative workflows, and direct versus indirect targeting strategies. Primary outcomes were seizure-frequency reduction and responder rate; secondary outcomes included perioperative adverse events and identification of pediatric-specific factors influencing surgical planning.</p> Results <p>Seventeen studies (10 DBS, 7 RNS; total <i>n</i> = 333 children) met inclusion criteria. Median age was 16.0 ± 6.35&#xa0;years; median epilepsy duration was 12.15 ± 7.98&#xa0;years; 41.4% carried a diagnosis of Lennox-Gastaut syndrome. Frame-based stereotaxy predominated (12/17 studies; 168/238 procedures, 70.6%), with robotic assistance in 20.6% (3/17; 49/238). Thirteen studies specified targeting method—nine direct, four indirect. Targets were the anterior nucleus of the thalamus (ANT; <i>n</i> = 25, 10.4%), centromedian nucleus (CMN; <i>n</i> = 200, 83.3%), pulvinar nucleus (PVN; <i>n</i> = 1, 0.4%), and hippocampus (HC; <i>n</i> = 14, 5.8%). Pooled weighted median seizure reduction was 54.7 ± 9.1% over a median follow-up of 20.4 ± 17.6&#xa0;months; pooled weighted median responder rate was 63.0 ± 17.3% over the same interval. Subgroup analyses showed target-dependent outcome variability. DBS versus RNS subgroup comparison showed no difference in seizure reduction but did show a difference in responder rates. Complication rate was 13.3%.</p> Conclusion <p>Stereotactic subcortical targeting in pediatric DRE achieves meaningful seizure reduction and responder rates, with acceptable safety. Direct and indirect targeting strategies must account for unique pediatric considerations. A practical tool for trajectory planning, imaging selection, and targeting methodology for DBS and RNS in children is provided.</p>

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Neurostimulation in children with drug-resistant epilepsy: strategies in subcortical targeting and systematic review of the evidence

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Derek D. George,
  • Melissa A. LoPresti,
  • Maryam N. Shahin,
  • Elysa Widjaja,
  • Andrew Wensel,
  • Neena I. Marupudi,
  • Jeffrey S. Raskin

摘要

Objective

The aim of this study is to delineate technical considerations for subcortical electrode targeting in children with DRE and to present a target selection decision-support tool for pediatric neurosurgeons for DBS and RNS.

Methods

A systematic review of studies through age ≤ 19 years reporting DBS or RNS implantation for DRE was performed. Articles were screened for details on trajectory planning, imaging parameters, intraoperative workflows, and direct versus indirect targeting strategies. Primary outcomes were seizure-frequency reduction and responder rate; secondary outcomes included perioperative adverse events and identification of pediatric-specific factors influencing surgical planning.

Results

Seventeen studies (10 DBS, 7 RNS; total n = 333 children) met inclusion criteria. Median age was 16.0 ± 6.35 years; median epilepsy duration was 12.15 ± 7.98 years; 41.4% carried a diagnosis of Lennox-Gastaut syndrome. Frame-based stereotaxy predominated (12/17 studies; 168/238 procedures, 70.6%), with robotic assistance in 20.6% (3/17; 49/238). Thirteen studies specified targeting method—nine direct, four indirect. Targets were the anterior nucleus of the thalamus (ANT; n = 25, 10.4%), centromedian nucleus (CMN; n = 200, 83.3%), pulvinar nucleus (PVN; n = 1, 0.4%), and hippocampus (HC; n = 14, 5.8%). Pooled weighted median seizure reduction was 54.7 ± 9.1% over a median follow-up of 20.4 ± 17.6 months; pooled weighted median responder rate was 63.0 ± 17.3% over the same interval. Subgroup analyses showed target-dependent outcome variability. DBS versus RNS subgroup comparison showed no difference in seizure reduction but did show a difference in responder rates. Complication rate was 13.3%.

Conclusion

Stereotactic subcortical targeting in pediatric DRE achieves meaningful seizure reduction and responder rates, with acceptable safety. Direct and indirect targeting strategies must account for unique pediatric considerations. A practical tool for trajectory planning, imaging selection, and targeting methodology for DBS and RNS in children is provided.