Neuromodulation Strategies in Lennox-Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium

Epilepsy Research, Journal Year: 2025, Volume and Issue: 210, P. 107499 - 107499

Published: Jan. 2, 2025

Language: Английский

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Cognitive and behavioral impact of antiseizure medications, neuromodulation, ketogenic diet, and surgery in lennox-gastaut syndrome: A comprehensive review

Epilepsy & Behavior, Journal Year: 2025, Volume and Issue: 164, P. 110272 - 110272

Published: Jan. 23, 2025

Language: Английский

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Neuromodulation strategies in developmental and epileptic encephalopathies

Epilepsy & Behavior, Journal Year: 2024, Volume and Issue: 160, P. 110067 - 110067

Published: Oct. 10, 2024

Language: Английский

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Efficacy and Safety of Vagus Nerve Stimulation in Lennox–Gastaut Syndrome: A Scoping Review

Children, Journal Year: 2024, Volume and Issue: 11(8), P. 905 - 905

Published: July 27, 2024

Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures, cognitive impairments, abnormal electroencephalographic patterns. Vagus nerve stimulation (VNS) widely used neuromodulation therapy for LGS, but its effects on seizure outcomes, different types, non-seizure adverse events in this population have not been comprehensively reviewed. To conduct scoping review the use of VNS literature search was performed PubMed, OVID, Web Science, Embase from inception to 9 June 2024, using relevant keywords without restrictions study design. The yielded forty eligible studies (twenty-four retrospective cohorts, fourteen prospective two registry analyses) comprising 1400 LGS patients treated with VNS. No randomized controlled trials were identified. Across studies, median reduction ranged 20.6% 65%, 0% 100% achieving ≥50% reduction. consistent preoperative biomarker responsiveness identified LGS. Although inconsistent among tonic, atonic, tonic-clonic seizures responded best, while focal worst. Improvements severity, alertness, quality life reported some adaptive functioning generally remained unchanged. Adverse mostly mild transient, including hoarseness, cough, paresthesia. Device-related complications infections uncommon. In conclusion, further research needed better understand VNS's position evolving treatment landscape cost effectiveness.

Language: Английский

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Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies

Epilepsia Open, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Neuromodulation for pediatric refractory epilepsy (PRE) is preferred when the seizure onset zone not amenable to surgical resection, due multifocal or involvement of eloquent cortex. Given its rapidly evolving landscape, we describe our institutional experience with neurostimulation therapies including deep brain stimulation (DBS) anterior nucleus (DBS-ANT), centromedian (DBS-CM), responsive (RNS), and chronic subthreshold (CSS) treat PRE. A retrospective chart review was conducted identify patients (≤18 years age) who presented institution Patients were included had at least 1 year follow-up after started. ≥50% frequency reduction last compared baseline classified as responders. total 35 (21 females) in series. Nine underwent DBS-ANT, 9 DBS-CM (+ ANT 7 patients), 5 RNS, 12 CSS. The median age surgery 8 16 years, respectively. Structural lesions most common etiology (54%). Eighteen prior interventions 13 received invasive EEG. Post-operative complications following implantation noted three (9%). However, no permanent deficits noted. Median time 46 months (range 13-162 months). Twenty-three (59%) responders (3/9 DBS-ANT; 7/9 DBS-CM; 4/5 RNS; 9/12 CSS). Further, 25% 89% 87% 88% across cohort. Six (17%) improved subjective neurocognitive outcomes while other 29 stable outcomes. DBS, CSS are safe effective options An understanding treatment approaches can optimize results by tailoring therapy individual patients. This study investigates use various treating (DBS), (CSS). Overall, neuromodulation found be reducing seizures patients, 59% showing a 50% frequency. Additionally, treatments generally safe, few instances deficits.

Language: Английский

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Sawtooth delta of the thalamus: A physiological variant and the intracranial generator of rapid-eye movement sleep sawtooth waves

Clinical Neurophysiology, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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Bridging the Gap in FDA Approval for Pediatric Neuromodulation Devices

Children, Journal Year: 2025, Volume and Issue: 12(2), P. 148 - 148

Published: Jan. 27, 2025

While neuromodulation devices for managing neurological conditions have significantly advanced, there remains a substantial gap in FDA-approved specifically designed pediatric patients. Devices like deep brain stimulators (DBS), vagus nerve (VNS), and spinal cord (SCS) are primarily approved adults, with few options children. To meet needs, off-label use is common; however, unique challenges to device development—such as ethical concerns, small trial populations, financial disincentives due the limited market size—continue hinder progress. This review examines these barriers development FDA (Food Drug Administration) approval, well current efforts, such initiatives consortia support, that address regulatory challenges. Furthermore, we discuss pathways Humanitarian Device Exemptions Real-World Evidence programs aim streamline approval process unmet clinical needs care. Addressing could expand access effective treatments improve patient

Language: Английский

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A comprehensive review of evolving treatment strategies for Dravet syndrome: Insights from randomized trials, meta-analyses, real-world evidence, and emerging therapeutic approaches

Epilepsy & Behavior, Journal Year: 2024, Volume and Issue: 162, P. 110171 - 110171

Published: Nov. 29, 2024

Language: Английский

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