An update on pediatric surgical epilepsy: Part II.
Authors: Gadgil N, Muir M, Lopresti MA, Lam SK
Recent advances may allow surgical options for pediatric patients with refractory epilepsy not previously deemed surgical candidates. This review outlines major technological developments in the field of pediatric surgical epilepsy. The literature was comprehensively reviewed and summarized pertaining to stereotactic electroencephalography (sEEG), laser ablation, focused ultrasound (FUS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in pediatric epilepsy patients. sEEG allows improved seizure localization in patients with widespread, bilateral, or deep-seated epileptic foci. Laser ablation may be used for destruction of deep-seated epileptic foci close to eloquent structures; FUS has a similar potential application. RNS is a palliative option for patients with eloquent, multiple, or broad epileptogenic foci. DBS is another palliative approach in children unsuitable for respective surgery. The landscape of pediatric epilepsy is changing due to improved diagnostic and treatment options for patients with refractory seizures. These interventions may improve seizure outcomes and decrease surgical morbidity, though further research is needed to define the appropriate role for each modality.
Introduction
Purpose
Thermal ablation
Study Objective
To review and summarize recent technological advances in surgical diagnostic and treatment options for pediatric patients with refractory epilepsy.
Disease model
pediatric refractory epilepsy
Outcomes and Safety
Summary of Outcomes
sEEG improves seizure localization for widespread, bilateral, or deep foci; laser ablation and focused ultrasound (FUS) offer minimally invasive destruction of deep-seated foci near eloquent cortex; responsive neurostimulation (RNS) and deep brain stimulation (DBS) serve as palliative neuromodulation options that can reduce seizure burden and surgical morbidity in pediatric refractory epilepsy. No specific FUS parameter sets were reported as tested or successful in this review.
Safety-related matter
The paper does not report specific adverse effects or safety events; it states these interventions may decrease or minimize surgical morbidity, though further research is needed to define the appropriate role for each modality.
Brain Region
Ultrasound Parameters
Focal Characteristics
Focal depth: None; Focal length: None; Aperture size: None
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