Intracranial stimulation for children with epilepsy

Abstract

Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary.

Deep brain stimulation for drug‐resistant epilepsy

“…10 12,22,32,[51][52][53][54] involving patients with refractory epilepsy, some of whom have Lennox-Gastaut syndrome or characteristics of Lennox-Gastaut syndrome-a childhood epilepsy featuring tonic and atonic seizures (Table 4). CMT stimulation may desynchronize and inhibit electrical conduction through these pathways, potentially interrupting or decreasing the risk of seizure activity.…”

“…Robust clinical trials demonstrate seizure frequency reductions of 40% following short-term ANT stimulation, 3 and 26%-40% following short-term HC stimulation, [34][35][36][37] in patients with primarily focal epilepsies. Pooled responder rates (seizure reduction ≥50%) were >70% for both ANT 9,18,19,[21][22][23][24][26][27][28][29][30][31][32][33] and HC-stimulated 13,14,[34][35][36][41][42][43][44][45][46][47] patients. Indeed, a recent meta-analysis found statistically significant reductions in seizure frequency secondary to ANT-DBS (high-quality evidence) and HC-DBS (moderate-quality evidence), but not for any other targets.…”

“…Given that this circuit is thought to be involved in emotional processing and seizure propagation, highfrequency ANT stimulation may inhibit the spread of focal seizures to cortical areas. 4,10,11,16,17 Current evidence for ANT-DBS includes one large-scale RCT 3,18 and 16 noncontrolled studies 8,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] (Table 2).…”

“…79 Our pooled analysis of patients for whom individual data were available (Figure 1) revealed that half of all ANT-DBS patients experienced a 46%-90% decline 9,18,19,[21][22][23][24]26,27,31 in seizures, and half of all HC-DBS patients experienced a 48%-95% decrease 13,[34][35][36][41][42][43][44][45][46][47] (interquartile ranges). Pooled responder rates (seizure reduction ≥50%) were >70% for both ANT 9,18,19,[21][22][23][24][26][27][28][29][30][31][32][33] and HC-stimulated 13,14,[34][35][36][41][42][43][44][45]…”

“…11 Many studies observed a lesional effect, that is, an immediate decrease in seizures after implantation but 9,18,19,[21][22][23][24]26,27,31 (anterior nucleus of the thalamus), N=62 13,34-36,41-47 (hippocampus), N=48 12,49,50,53,54 (centromedian nucleus of the thalamus), N=17 12,55,57 (cerebellum), and N=12 15,21,61,62 (subthalamic nuclei). RR values calculated from N=14 18,19,[21][22][23][24][26][27][28][29][30][31][32][33]39 (anterior nucleus of the thalamus), N=69 13,14,[34][35][36][41][42][43][44][45][46][47] (hippocampus), N=51 12,22,32,49,50,…”