Recent advances in the neurosurgical treatment of pediatric epilepsy

Abstract

The field of epilepsy surgery has seen tremendous growth in recent years. Innovative new devices have driven much of this growth, but some has been driven by revisions of existing products. Devices have also helped to rejuvenate existing procedures, as in the case of robotic assistance for electrode placement for stereo-electroencephalography, and these devices have brought significant attention along with their introduction. Other devices, such as responsive neurostimulators or laser interstitial thermal therapy systems, have introduced novel treatment modalities and broadened the surgical indications. Collectively, these advances are rapidly changing much of the landscape in the world of pediatric neurosurgery for medically refractory epilepsy. The foundations for indications for neurosurgical intervention are well supported in strong research data, which has also been expanded in recent years. In this article, the authors review advances in the neurosurgical treatment of pediatric epilepsy, beginning with trials that have repeatedly demonstrated the value of neurosurgical procedures for medically refractory epilepsy and following with several recent advances that are largely focused on less-invasive intervention.

National 22‐year epilepsy surgery landscape shows increasing open and minimally invasive pediatric epilepsy surgery

“…Multiple advancements in the field of epilepsy surgery coincide around this time including but not limited to the release of the American Academy of Neurology guidelines for surgical evaluation, advancements in neuromodulatory technology, and adoption of stereo-encephalography in North America. 21,22 The infrastructure of surgical care for pediatric epilepsy is largely determined by access to and management by NAECs. The documented increase in NAECs, in the latter half of our 20-year analysis, does not appear to have resulted in increased surgical volume.…”

Neuromodulation for the Treatment of Epilepsy: A Review of Current Approaches and Future Directions

“…76 Surgery does remain an important option for pediatric patients with drug-resistant epilepsy. 77,78 In addition, it is noteworthy that current neuromodulatory approaches rarely achieve complete seizure freedom alone. Indeed, response rate is defined as a 50% reduction in seizure frequency.…”

Responsive neurostimulation in pediatric patients with drug-resistant epilepsy

“…6 RNS is a closed-loop system that is designed to detect abnormal electrical signals from the suspected seizure onset zone (SOZ) by using digital signal analysis of electroencephalography (EEG) through a predefined seizure detection algorithm, and delivering a stimulus to arrest the seizure. 7,8 RNS is an FDA-approved system for the management of DRE in adults 8,9 but has only been used off label in children when no other treatment options are available. 7,[9][10][11] A retrospective analysis of 5 different pediatric centers identified 35 patients who underwent RNS implantation, 17 of whom were younger than 18 years old.…”