Thalamic neuromodulation for pediatric drug-resistant epilepsy: a case series evaluating deep brain stimulation and responsive neurostimulation.
Most children with drug-resistant epilepsy responded to thalamic neuromodulation therapy.
Thalamic neuromodulation for pediatric drug-resistant epilepsy: a case series evaluating deep brain stimulation and responsive neurostimulation.
This single-institution case series describes, to our knowledge, the largest pediatric cohort treated with thalamic deep brain stimulation or responsive neurostimulation for generalized or multifocal drug-resistant epilepsy, providing descriptive data on safety and seizure burden.
The authors performed a retrospective chart review of pediatric patients with drug-resistant epilepsy who underwent thalamic neuromodulation using responsive neurostimulation or deep brain stimulation at Seattle Children's Hospital between January 2020 and July 2025 with at least 6 months of follow-up.
nearly two thirds had seizures cut by half or more
Twenty-six patients (mean age 14.5, range 6-20 years) underwent thalamic neuromodulation with deep brain stimulation (n = 12) or responsive neurostimulation (n = 14).
The centromedian nucleus was the target in 24 cases; 1 patient each underwent targeting of the anterior nucleus and pulvinar nucleus.
The median seizure reduction was 75.7% for deep brain stimulation and 37.5% for responsive neurostimulation.
A significant downward shift in seizure frequency was observed postoperatively across the entire cohort (p = 0.031), including among patients with the highest baseline seizure burden.
Thalamic neuromodulation using deep brain stimulation and responsive neurostimulation was safe and well tolerated in pediatric patients with drug-resistant epilepsy, including multifocal and generalized seizure onsets.
Meaningful seizure reduction was observed across a range of epilepsy phenotypes, with a trend toward greater benefit in the deep brain stimulation group.
These findings support thalamic neuromodulation as a promising treatment option in children with nonlesional drug-resistant epilepsy and highlight the need for prospective multicenter studies with extended follow-up.