What do I need to know?
Children who are not eligible for resective epilepsy surgery, or who have had unsuccessful prior surgeries, often attempt the ketogenic diet or vagal nerve stimulation (VNS).
A newer approach targets areas of the brain involved in the spread of seizures. This is called deep brain stimulation.
What is deep brain stimulation?
Deep brain stimulation uses electrodes that are implanted in deep areas of the brain. These electrodes communicate with a neurostimulator implanted inside the chest wall. The neurostimulator triggers the electrode to zap parts of the brain through which seizures spread. This blocks seizures from spreading to other parts of the brain.
The two most common areas of the brain where electrodes are implanted are the centromedian nucleus of the thalamus (CM) and the anterior nucleus of the thalamus (ANT).
Is deep brain stimulation effective in children?
Overall, studies show that 85% of children see more than 50% reduction in seizures. About 12% of children are seizure-free with deep brain stimulation.
Yan, H., Toyota, E., Anderson, M., Abel, T. J., Donner, E., Kalia, S. K., Drake, J., Rutka, J. T., & Ibrahim, G. M. (2019). A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood, Journal of Neurosurgery: Pediatrics PED, 23(3), 274-284
The use of deep brain stimulation in children is new. There are only few studies which look at the effectiveness of this treatment in children. The effectiveness of deep brain stimulation can vary depending on many factors, including which parts of the brain are stimulated:
- Centromedian nucleus of the thalamus (CM): In one study, researchers looked at 18 children who had unilateral or bilateral CM stimulation. 17 our of 18 children had more than 50% reduction in seizure frequency.
- Anterior nucleus of the thalamus (ANT): In the same study, researchers looked at 8 children who had ANT stimulation. Five out of eight children had more than 50% reduction in seizure frequency. There is some evidence that suggests deep brain stimulation in this region of the brain improves memory and cognition.
Other parts of the brain that have been stimulated in children include the hippocampus, subthalamic nucleus, mamillothalamic tract, and caudal zona incerta.
More research is needed to see if deep brain stimulation is effective in children.
Where can my child get deep brain stimulation?
Deep brain stimulation is approved in the U.S. for adults only. However, some surgeons are using deep brain stimulation “off label” in children.
You will need to ask your child’s team whether the epilepsy surgeon uses deep brain stimulation in children.
CONNECT WITH OTHERS
The following online communities are provided for your information only. We do not endorse or guarantee the accuracy of statements posted by others.
RNS, VNS, DBS for Epilepsy Support Group (Facebook)
Pediatric Epilepsy Surgery Support (Facebook)
Vagus Nerve Stimulation, Deep Brain Stimulation, and Responsive Neurostimulation
Dr. Taylor Abel, MD, FAANS, is the Director of the Pediatric Epilepsy Surgery Program at UPMC Children’s Hospital of Pittsburgh and Dr. George M Ibrahim, MD, PhD, FRCSC, FAANS, is a pediatric neurosurgeon at The Hospital for Sick Children in Toronto, Canada, Assistant Professor at the Institute of Biomaterials and Biomedical Engineering, and Institute of Medical Science, Department of Surgery at the University of Toronto, and Associate Scientist Program in Neuroscience and Mental Health at SickKids Research Institute. Here, Drs. Abel and Ibrahim discuss vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation.
Sources
Yan, H., Toyota, E., Anderson, M., Abel, T. J., Donner, E., Kalia, S. K., Drake, J., Rutka, J. T., & Ibrahim, G. M. (2018). A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood. Journal of neurosurgery. Pediatrics, 23(3), 274–284. https://doi.org/10.3171/2018.9.PEDS18417.