Two Brain Stimulation Options Help Children With Hard-To-Treat Epilepsy

What was studied

This study looked at thalamic neuromodulation for children with drug-resistant epilepsy, meaning epilepsy that did not respond well to medicines. The two treatments studied were deep brain stimulation (DBS) and responsive neurostimulation (RNS), both targeting thalamic nuclei.

Researchers reviewed past records from 12 centers and included 221 children treated between 2015 and 2024. Of these, 111 had DBS and 110 had RNS. They compared seizure outcomes at 3, 6, and 12 months after surgery, along with antiseizure medications and surgical complications.

What they found

At 12 months, DBS and RNS had similar overall results for reducing seizures, based on responder rates and Engel outcome scores. A responder meant a child had more than 50% fewer seizures.

The timing of improvement was different. With DBS, about 41.7% were responders by 3 months, and response rates remained comparatively stable over time. With RNS, responder rates increased from 26.9% at 3 months to 55.6% at 12 months.

DBS had a higher rate of seizure freedom at 12 months than RNS in this study: 9.5% versus 1.2%. The study did not find that thalamic target selection or epilepsy diagnosis predicted seizure outcome. Safety profiles were reported as equivalent.

Limits of the evidence

This was a retrospective study, so the researchers looked back at existing records rather than randomly assigning children to one treatment or the other. That means the study cannot show with certainty that the device itself caused the differences seen.

Children were treated at different centers over many years, and treatment choices may have depended on factors not fully captured in the records. The abstract does not give full details about which children were selected for each device, the exact complication rates, or longer-term results beyond 12 months. Because of this, some uncertainty remains.

For families and caregivers

For families considering surgery for hard-to-treat epilepsy, this study suggests that both DBS and RNS may help some children when medicines have not worked. The results also suggest that DBS may be linked with earlier seizure improvement, while RNS may show a more gradual increase in response over time.

The study may help with discussions about what to expect after surgery, but it does not show that one option is best for every child. Decisions still depend on the child’s overall situation and the experience of the care team.

What to watch next

Longer follow-up and studies that compare DBS and RNS in more similar groups of children would help clarify how these treatments compare over time.

Terms in this summary

drug-resistant epilepsy

Epilepsy that continues despite trying appropriate seizure medicines.

neuromodulation

Treatment that changes brain activity using an implanted device that sends electrical signals.

thalamus

A deep part of the brain involved in passing signals between brain regions.

deep brain stimulation (DBS)

A treatment that sends electrical stimulation to a brain target through implanted wires.

responsive neurostimulation (RNS)

A device that detects abnormal brain activity and gives stimulation in response.

Engel class

A common way to rate seizure outcome after epilepsy treatment, including whether seizures stopped or improved.

responder rate

The percentage of patients who had at least a 50% drop in seizures.

seizure freedom

Having no seizures during the follow-up period being measured.