Deep Brain Stimulation of Bilateral Centromedian Thalamic Nuclei in Pediatric Patients with Lennox-Gastaut Syndrome: An Institutional Experience.

INTRODUCTION: Surgical management of pediatric patients with non-lesional, drug-resistant epilepsy (DRE), including patients with Lennox-Gastaut Syndrome (LGS), remains a challenge given the lack of resective targets in most patients, and demonstrates seizure freedom rates <50% at 5-years. The efficacy of deep brain stimulation (DBS) is less certain in children than adults. This study examined clinical and seizure outcomes for pediatric patients with LGS undergoing DBS targeting of the centromedian thalamic nuclei (CMTN).

METHODS: IRB-approved retrospective analysis of patients ≤19-years with clinical diagnosis of LGS undergoing bilateral DBS placement to the CMTN from 2020-2021 by a single surgeon.

RESULTS: Four females and 2 males, aged 6-19 years were identified. Before surgery, each child experienced at least 6-years of refractory seizures; 4 children experienced seizures since infancy. All took antiseizure medications at time of surgery. Five children had prior placement of a vagus nerve stimulator, 2 had previous corpus callosotomy. Mean length of stay following DBS was 2-days. No children experienced adverse neurological effects from implantation; mean follow-up time was 16.3 months. Four patients had >60% reduction in seizure frequency following surgery, 1 patient experienced 10% reduction, 1 patient demonstrated no change. No children reported worsening seizure symptoms post-surgery.

CONCLUSIONS: Our study contributes to the sparse literature describing CMTN DBS for children with DRE from LGS. Our results suggest that CMTN DBS is a safe and effective therapeutic modality that should be considered as alternative or adjuvant therapy for this challenging patient population. Further studies with larger patient populations are warranted.