Thalamic neuromodulation has emerged as a treatment option for drug-resistant epilepsy (DRE) with widespread and/or undefined epileptogenic networks. While deep brain stimulation (DBS) and responsive neurostimulation (RNS) depth electrodes offer means for electrical stimulation of the thalamus in adult patients with DRE, the application of thalamic neuromodulation in pediatric epilepsy remains limited. To address this gap, the Neuromodulation Expert Collaborative was established within the Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Special Interest Group. In this expert review, existing evidence and recommendations for thalamic neuromodulation modalities using DBS and RNS are summarized, with a focus on the anterior (ANT), centromedian(CMN), and pulvinar nuclei of the thalamus. To-date, only DBS of the ANT is FDA approved for treatment of DRE in adult patients based on the results of the pivotal SANTE (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy) study. Evidence for other thalamic neurmodulation indications and targets is less abundant. Despite the lack of evidence, positive responses to thalamic stimulation in adults with DRE have led to its off-label use in pediatric patients. Although caution is warranted due to differences between pediatric and adult epilepsy, the efficacy and safety of pediatric neuromodulation appear comparable to that in adults. Indeed, CMN stimulation is increasingly accepted for generalized and diffuse onset epilepsies, with recent completion of one randomized trial. There is also growing interest in using pulvinar stimulation for temporal plus and posterior quadrant epilepsies with one ongoing clinical trial in Europe. The future of thalamic neuromodulation holds promise for revolutionizing the treatment landscape of childhood epilepsy. Ongoing research, technological advancements, and collaborative efforts are poised to refine and improve thalamic neuromodulation strategies, ultimately enhancing the quality of life for children with DRE.

中文翻译：

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推进癫痫的丘脑神经调节：将成人数据与儿科护理联系起来


丘脑神经调节已成为具有广泛和/或不确定的致癫痫网络的耐药性癫痫（DRE）的治疗选择。虽然深部脑刺激 (DBS) 和响应性神经刺激 (RNS) 深度电极提供了对成年 DRE 患者丘脑进行电刺激的方法，但丘脑神经调节在小儿癫痫中的应用仍然有限。为了解决这一差距，小儿癫痫研究联盟 (PERC) 癫痫手术特别兴趣小组内成立了神经调节专家合作组织。在本次专家评审中，总结了使用 DBS 和 RNS 进行丘脑神经调节模式的现有证据和建议，重点关注丘脑的前核 (ANT)、中心正中核 (CMN) 和枕丘核。迄今为止，根据关键 SANTE（刺激丘脑前核治疗癫痫）研究的结果，只有 ANT 的 DBS 被 FDA 批准用于治疗成人患者的 DRE。其他丘脑神经调节适应症和目标的证据并不丰富。尽管缺乏证据，但患有 DRE 的成人对丘脑刺激的积极反应导致其在儿科患者中超说明书使用。尽管由于儿童和成人癫痫之间的差异而需要谨慎，但儿童神经调节的有效性和安全性似乎与成人相当。事实上，随着最近完成的一项随机试验，CMN 刺激越来越被接受用于治疗全身性和弥漫性癫痫。人们对使用枕刺激治疗颞叶正位和后象限癫痫也越来越感兴趣，欧洲正在进行一项临床试验。 丘脑神经调节的未来有望彻底改变儿童癫痫的治疗格局。持续的研究、技术进步和合作努力将完善和改进丘脑神经调节策略，最终提高 DRE 儿童的生活质量。