OBJECTIVE Responsive neuromodulation with the Responsive Neurostimulation (RNS) System is an important treatment option for pediatric patients with drug-resistant epilepsy. Early reports on seizure reduction and safety have been encouraging, but there is a need for greater understanding of evolving indications, treatment approaches, and outcomes in this population. The authors report patient characteristics, adverse events, seizure outcoames, quality-of-life outcomes, and programming details for young patients treated at their institution, focusing on pediatric outcomes. METHODS A retrospective review of all patients treated in the Massachusetts General Hospital Pediatric RNS Clinic between August 2020 and January 2025 was conducted. Clinical characteristics, seizure frequency, and programming parameters were collected for each patient. Primary outcome was seizure response at 12 months after implantation. Secondary outcomes included seizure response at last follow-up, change in antiseizure medications at last follow-up, responses to a questionnaire focused on quality of life at last follow-up, and adverse surgical or stimulation-related events. RESULTS Thirty-two patients underwent RNS implantation (63% female, mean range age 15 6–28 years) with a median follow-up of 24 months, including 27 children ≤ 18 years (47% female) with median follow-up 22 months. RNS targets were bilateral thalamic (n = 24), cortical (n = 3), hippocampal (n = 2), and corticothalamic (n = 3). No surgical complications occurred. Stimulation-related adverse effects occurred in 44% of patients (36% pediatric). Among patients with at least 1 year of follow-up (n = 24 19 pediatric), the responder rate at 12 months was 79% (74% pediatric), with median 78% seizure reduction (p = 0.0003) (pediatric 73%, p = 0.0097). At last follow-up, the responder rate was 92% (89% pediatric), with 91% median seizure reduction (p = 0.0002) (pediatric 90%, p = 9.9 × 10 −8 ); 54% of patients were super responders (53% pediatric). No clinical characteristics evaluated were significantly different between responders and nonresponders. Patients reported significant improvements in quality of life across categories related to physical activities and activities of daily living (p = 0.003, pediatric p = 0.009), cognition and school (p = 0.0006, pediatric p = 0.001), social and mood (p = 0.03, pediatric p = 0.05), and seizures (p = 1.8 × 10 −6 , pediatric p = 1.3 × 10 −5 ). CONCLUSIONS The authors’ cohort of young patients with severe drug-resistant epilepsy from a variety of etiologies experienced comparable improvements in seizure control at 12 months to that reported in adults at 9 years. Patients also reported improvements in quality of life. These robust outcomes may be due to empirical targeting of patient-specific seizure networks and rapid escalation of therapy to higher treatment parameters.
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