Antonio Valentín1, Richard P Selway2, Meriem Amarouche2, Nilesh Mundil2, Ismail Ughratdar2, Leila Ayoubian3, David Martín-López4, Farhana Kazi5, Talib Dar3, Diego Jiménez-Jiménez6, Elaine Hughes7, Gonzalo Alarcón8. 1. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK. Electronic address: antonio.valentin@kcl.ac.uk. 2. Department of Neurosurgery, King's College Hospital NHS Trust, London, UK. 3. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. 4. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, Kingston Hospital NHS FT, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain. 5. Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK. 6. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador. 7. Department of Paediatric Neurosciences, King's College Hospital NHS Trust, London, UK; Department of Paediatric Neurology, Evelina Children's Hospital, London, UK. 8. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Comprehensive Epilepsy Center, Neuroscience Institute, Academic Health Systems Hamad Medical Corporation, Doha, Qatar.
Abstract
OBJECTIVES: To evaluate the efficacy of intracranial stimulation to treat refractory epilepsy in children. METHODS: This is a retrospective analysis of a pilot study on all 8 children who had intracranial electrical stimulation for the investigation and treatment of refractory epilepsy at King's College Hospital between 2014 and 2015. Five children (one with temporal lobe epilepsy and four with frontal lobe epilepsy) had subacute cortical stimulation (SCS) for a period of 20-161 h during intracranial video-telemetry. Efficacy of stimulation was evaluated by counting interictal discharges and seizures. Two children had thalamic deep brain stimulation (DBS) of the centromedian nucleus (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy), and one child on the anterior nucleus (right fronto-temporal epilepsy). The incidence of interictal discharges was evaluated visually and quantified automatically. RESULTS: Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children with SCS, four showed improvement in seizure frequency (>50%) and one chid did not show improvement. Procedures were well tolerated by children. CONCLUSION: Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary.
OBJECTIVES: To evaluate the efficacy of intracranial stimulation to treat refractory epilepsy in children. METHODS: This is a retrospective analysis of a pilot study on all 8 children who had intracranial electrical stimulation for the investigation and treatment of refractory epilepsy at King's College Hospital between 2014 and 2015. Five children (one with temporal lobe epilepsy and four with frontal lobe epilepsy) had subacute cortical stimulation (SCS) for a period of 20-161 h during intracranial video-telemetry. Efficacy of stimulation was evaluated by counting interictal discharges and seizures. Two children had thalamic deep brain stimulation (DBS) of the centromedian nucleus (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy), and one child on the anterior nucleus (right fronto-temporal epilepsy). The incidence of interictal discharges was evaluated visually and quantified automatically. RESULTS: Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children with SCS, four showed improvement in seizure frequency (>50%) and one chid did not show improvement. Procedures were well tolerated by children. CONCLUSION: Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary.
Authors: Han Yan; Lauren Siegel; Sara Breitbart; Carolina Gorodetsky; Hernan D Gonorazky; Ivanna Yau; Cristina Go; Elizabeth Donner; Suneil K Kalia; Alfonso Fasano; Alexander G Weil; Aria Fallah; George M Ibrahim Journal: Childs Nerv Syst Date: 2020-09-15 Impact factor: 1.475
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Authors: Han Yan; Lauren Siegel; Sara Breitbart; Carolina Gorodetsky; Alfonso Fasano; Aliya Rahim; Alvin Loh; Abhaya V Kulkarni; George M Ibrahim Journal: Pilot Feasibility Stud Date: 2022-02-02