Brain implant for adults with epilepsy can also help children

By Adam Meyer
HealthDay Reporter

MONDAY, Jan. 24 (HealthDay News) — A brain implant that helps manage severe epilepsy in adults may do the same for children who suffer from relentless seizures, new research suggests.

The study is one of the first to examine the responsive neurostimulation system (RNS) in children.

RNS has already been approved by the US Food and Drug Administration for adult patients with drug-resistant epilepsy, but research on safety and efficacy in children is limited.

“As we expand the use of RNS for children, it is critical to consider how to determine the lower age limit,” said study author Dr. Yasunori Nagahama, director of pediatric epilepsy surgery at Rutgers Robert Wood Johnson Medical School in New Jersey.

Since this procedure involves removing a portion of the skull to implant the device, the benefits and potential harm based on variable skull development in individual patients must be considered. Children experience rapid skull growth within the first two years, reaching about 90% of adult skull volume by age 8,” Nagahama stated in a Rutgers press release.

“In this study, there were two patients younger than 7 years of age at the time of RNS implantation, including a 3-year-old, who was the youngest reported patient to undergo RNS implantation,” he added.

Nagahama and his team looked at 35 children and young adults, ages 3 to 25, who were plagued with drug-resistant epilepsy and treated with RNS. Thereafter, 84% of patients saw a reduction in disabling seizures, including 18% who had greater than 90% reduction, and 6% who achieved complete seizure freedom.

RNS involves implanting a device (similar to a pacemaker) that sends electrical charges directly to the brain and stimulates it when necessary to prevent seizures. This system is increasingly being used in pediatric centers to help control seizures.

Of those plagued by seizures, up to 40% do not respond to medication, the study authors noted.

As an alternative to medication, RNS works by monitoring brain wave activity to detect developing seizures or unusual electrical activity that can trigger seizures. The implanted device then delivers small stimulation pulses to return the brain waves to normal.

“The findings suggest that responsive neurostimulation is an effective off-label surgical treatment of drug-resistant epilepsy in carefully selected pediatric patients,” Nagahama said. “However, more research is needed on its long-term efficacy and safety to determine which patients will benefit the most.”

Of the 35 patients in the study, only three experienced complications that required additional surgery. Interestingly, these complications were noted only in the young adults, not the younger children.

The findings were recently published in the journal Neurosurgery.

Despite the positive findings, RNS carries risks, according to two experts who were not involved in the study.

“The RNS device is implanted in the skull and in very young children there may be a risk of complications related to continued skull growth,” said Dr. Keith Starnes, a pediatric epileptologist at the Mayo Clinic in Rochester, Minnesota. skull growth and thickness should be considered on a case-by-case basis and the potential benefits of neuromodulation weighed against the potential for complications for an individual patient.”

Another caveat to consider for RNS is monitor battery life, Starnes noted.

“The expected battery life for RNS is currently about five to nine years. For children who have a longer expected remaining life than adults, this could mean multiple skull surgeries to replace the battery,” he explained. “It’s possible that this concern could be addressed in the future through advances in battery life and other technologies, but for now this is an important consideration.”

Still, the findings suggest that RNS is an effective, safe, and well-tolerated treatment that may reduce the rate of disabling seizures in children with epilepsy. But pediatric specialists must carefully select patients, who can be as young as 3, to determine if the implant is an appropriate treatment for their condition.

dr. Aparna Polavarapu, a pediatric epilepsy specialist and assistant professor at the Montefiore Health System in New York City, said: “RNS offers a new way to approach seizure treatment; without the use of daily medications that may require periodic blood tests. , be aware of, or monitor systemic side effects.”

More information

For more information about epilepsy, visit the US Centers for Disease Control and Prevention.

SOURCES: Rutgers University, press release, Jan. 5, 2022; Keith Starnes, MD, Member, Epilepsy Society, and Pediatric Epileptologist, Mayo Clinic, Rochester, Minn.; Aparna Polavarapu, MD, pediatric epilepsy specialist and assistant professor, Montefiore Health System, New York City; Neurosurgery, December 2021

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