Pediatric Epilepsy Neuromodulation: What This Review Found

What was studied

This systematic review and meta-analysis examined neuromodulation treatments for people younger than 18 years with drug-resistant epilepsy. Researchers searched four medical databases through August 2025 and included 88 studies involving 3,068 pediatric patients.

The review included 2,784 patients treated with vagus nerve stimulation (VNS), 182 with responsive neurostimulation (RNS), and 102 with deep brain stimulation (DBS). The main outcome was the percentage of patients whose seizures decreased by at least 50%. The researchers also examined seizure freedom and complications.

What they found

For VNS, the pooled responder rate was 54%, the seizure-freedom rate was 6%, and the complication rate was 4%. For RNS, the pooled responder rate was 71%, the seizure-freedom rate was 6%, and the complication rate was 6%. For DBS, the pooled responder rate was 65% and the complication rate was 15%. Seizure freedom with DBS was rare: it was reported in only one included study and was not observed in the remaining DBS studies. No procedure-related deaths were reported.

DBS exclusively targeted parts of the thalamus, while RNS predominantly used focal stimulation at seizure-onset areas. Overall, the treatments were associated with meaningful seizure reduction, but complete seizure freedom was uncommon.

Limits of the evidence

The evidence base was substantially larger for VNS than for RNS or DBS, and the pooled estimates for RNS and DBS had wider confidence intervals. The results should not be used to conclude that one treatment is better than another because the abstract reports no direct head-to-head comparisons.

The abstract does not provide details about study quality, study designs, follow-up length, outcomes by epilepsy type, or how complications were defined. It therefore provides limited information about comparative and long-term outcomes.

For families and caregivers

These findings suggest that VNS, RNS, and DBS may reduce seizures for some children whose epilepsy has not responded adequately to medicines. However, complete seizure freedom was uncommon. Treatment selection should be individualized based on the child's epilepsy characteristics, age, and practical considerations.

What to watch next

Further research could clarify direct comparisons among these treatments, longer-term outcomes, and safety using consistent definitions.

Terms in this summary

Drug-resistant epilepsy

Epilepsy that has not been adequately controlled with anti-seizure medicines.

Neuromodulation

Treatment that uses electrical stimulation to alter activity in the nervous system.

Vagus nerve stimulation (VNS)

An implanted device that sends electrical signals through the vagus nerve to help reduce seizures.

Responsive neurostimulation (RNS)

An implanted system that monitors brain activity and delivers stimulation in response.

Deep brain stimulation (DBS)

An implanted system that sends electrical stimulation to selected areas deep in the brain.

Responder rate

The percentage of patients whose seizure frequency decreased by at least 50%.

Confidence interval

A range describing uncertainty around an estimated result; wider ranges indicate greater uncertainty.

Thalamus

A structure deep in the brain involved in communication among brain networks.