Brain implant for adults with epilepsy can help children too


by Adam Mayer
HealthDay Reporter

MONDAY, Jan. 24, 2022 (HealthDay News) — A brain implant that helps control epilepsy in adults it can do the same for children who suffer from relentless seizuressuggests new research.

The study is one of the first to examine the sensitive neurostimulation (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 has been limited.

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

“Given that this procedure involves removal of a portion of the skull to implant the device, potential benefits and harms should be considered based on the variable development of the skull in individual patients. Children experience rapid skull growth in the first two years and reach about 90 percent of the adult skull volume by about age 8,” Nagahama explained in a Rutgers news release.

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

Nagahama and her team looked at 35 children and young adults, ages 3 to 25, who suffered from drug resistance. epilepsy and were treated with RNS. Subsequently, 84% of patients noted a reduction in disabling seizures, including 18% who had a greater than 90% reduction and 6% who achieved complete seizure freedom.

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

Of those harassed by epileptic seizuresup to 40 percent do not respond to medications, the study authors noted.

As an alternative to medication, RNS works by monitoring brain wave activity to detect developing seizures or any unusual electrical activity that may trigger seizures. The implanted device then delivers small pulses of stimulation to help bring your brain waves back to normal.

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

Among the 35 patients in the study, only three experienced complications that required additional surgery. Interestingly, these complications were seen only in young adults, not in 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. “The variability in skull growth and thickness must be considered on a case-by-case basis, and the potential benefits of neuromodulation must be weighed against the possibility of complications for an individual patient.”

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

“The expected battery life for RNS is currently about five to nine years. For children who have a longer remaining life expectancy than adults, this could mean several more skull surgeries to replace the battery,” he explained. . “This concern may be eliminated in the future with advances in battery life and other technologies, but for now it’s an important consideration.”

Still, the findings suggest that RNS is an effective, safe, and well-tolerated treatment that can reduce the number of disabilities. seizures in children with epilepsy. But pediatric specialists must carefully screen patients, who can be as young as 3 years old, 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 provides a new way to approach seizure management — without the use of daily medications that may require regular blood tests, drug interactions to be aware of, or systemic side effects to monitor.”

More information

Visit the US Centers for Disease Control and Prevention to learn more about epilepsy.

SOURCES: Rutgers University, news release, Jan. 5, 2022; Keith Starnes, MD, a member of the Epilepsy Society and a pediatric epileptologist at Mayo Clinic, Rochester, Minn.; Aparna Polavarapu, MD, pediatric epilepsy specialist and assistant professor, Montefiore Health System, New York City; Neurosurgerydecember 2021


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