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. 2025 Jul;66(7):2225-2238.
doi: 10.1111/epi.18393. Epub 2025 Apr 1.

Deep brain stimulation of the centromedian nucleus for drug-resistant epilepsy in children: Quality-of-life and functional outcomes from the CHILD-DBS registry

Karim Mithani  1   2   3 , Farbod Niazi  2 , Hrishikesh Suresh  1   2   3 , Yousof Alrumayyan  4 , Eriberto R Rayco  4 , Ayako Ochi  4 , Hiroshi Otsubo  4 , Elizabeth Kerr  4 , Sara Breitbart  3 , Andrea LeBlanc-Millar  4 , Nisha Gadgil  5 , Jeffrey S Raskin  6 , Alexander G Weil  7 , Aristides Hadjinicolaou  8 , Christian Iorio-Morin  9 , Shelly Weiss  4 , Puneet Jain  4 , Lauren Sham  4 , Elizabeth Donner  4 , Alfonso Fasano  4   10   11   12 , Carolina Gorodetsky  4 , George M Ibrahim  1   2   3   10
Affiliations

Deep brain stimulation of the centromedian nucleus for drug-resistant epilepsy in children: Quality-of-life and functional outcomes from the CHILD-DBS registry

Karim Mithani et al. Epilepsia. 2025 Jul.

Abstract

Objective: Deep brain stimulation of the centromedian nucleus of the thalamus (CM-DBS) is an investigational, off-label treatment for drug-resistant epilepsy (DRE) in children. Although emerging evidence supports its safety and efficacy for select indications, the effect of CM-DBS on quality of life and functional outcomes such as school attendance has not been studied. Here, we analyzed data from the prospective CHILD-DBS (Child & Youth Comprehensive Longitudinal Database for Deep Brain Stimulation) to examine the impact of CM-DBS on patient- and caregiver-reported outcomes.

Methods: Twenty-two children and youth underwent bilateral CM-DBS. Caregiver-child dyads completed surveys related to seizure frequency, seizure severity, quality of life, and school attendance at baseline, 6 months, and 1 year postsurgery. Simulated volumes of tissue activation were analyzed to identify optimal stimulation targets associated with treatment outcome.

Results: Of 22 children, 10 experienced ≥50% reduction in seizure frequency (mean reduction = 66.7 ± 17.3%), one exhibited a modest benefit (37.5% reduction), and the remaining 11 experienced no change. The majority (73% of patients) exhibited a clinically important reduction in seizure severity, including six children who did not demonstrate any change in seizure frequency. Only those who experienced a reduction in seizure frequency demonstrated significant improvements in general health and overall quality of life. Furthermore, we observed an increase in school attendance across participants 1 year after CM-DBS.

Significance: CM-DBS can lead to reduction in seizure burden concurrent with improvements in quality of life and relevant functional outcomes in children with DRE. These findings further our understanding of the impact of CM-DBS on meaningful outcomes for children and caregivers.

Keywords: centromedian nucleus; deep brain stimulation; drug‐resistant epilepsy; pediatrics; quality of life.

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Conflict of interest statement

K.M., F.N., H.S., Y.A., E.R.R., A.O., H.O., E.K., S.B., A.L.‐M., N.G., J.S.R., A.G.W., A.H., C.I.‐M., S.W., P.J., L.S., and E.D. have nothing to disclose. A.F., C.G., and G.M.I. receive consulting or advisory fees from Medtronic. A.F. also receives consulting and speaking fees from Boston Scientific and Abbott. G.M.I. also reports a relationship with Synergia and LivaNova that includes consulting and advisory fees and investigator‐initiated funding. These organizations played no role in any part of this study, including its design, conduct, analysis, and writing. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

FIGURE 1
FIGURE 1
Baseline characteristics and changes in seizure frequency after deep brain stimulation of the centromedian nuclei of the thalamus (CM‐DBS) in children. (A) Children and adolescents, aged 5–18 years at the time of surgery, were included in this study. Most children (59%) had a known developmental and epileptic encephalopathy. (B) Participants exhibited either a significant reduction in seizure frequency (n = 11, 50%) or no change (n = 11, 50%) over the 1‐year follow‐up period. (C) Individual participant data demonstrating percent change in seizure frequency between baseline and final follow‐up. Ten participants exhibited ≥50% reduction, one exhibited a modest benefit, and the remaining experienced no change. (D) Probabilistic stimulation mapping revealed bilaterally paired sweet spots in the anterolateral CM, as well as a sweet spot in the right posteromedial CM, where stimulation was associated with greater reduction in seizure frequency. A probabilistic atlas‐based parcellation of the CM is overlaid in blue. EI‐DEE, early infantile developmental and epileptic encephalopathy; IESS, infantile epileptic spasms syndrome; LGS, Lennox–Gastaut syndrome; AC, Anterior Commissure; PC, Posterior Commissure.
FIGURE 2
FIGURE 2
Changes in seizure severity, quality of life, and functional outcomes after deep brain stimulation of the centromedian nuclei of the thalamus (CM‐DBS). (A) Participants exhibited significant reductions in seizure severity (total Seizure Severity Questionnaire [SSQ] score) 1 year after undergoing CM‐DBS. Half of patients who experienced a clinically meaningful reduction in seizure severity did not exhibit a change in seizure frequency. (B) Participants also exhibited significant improvements in school attendance and quality of life, indexed by total Quality of Life in Childhood Epilepsy (QOLCE) score, over the study period. Asterisk (*) denotes a statistically significant difference.
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References

    1. Freilinger M, Reisel B, Reiter E, Zelenko M, Hauser E, Seidl R. Behavioral and emotional problems in children with epilepsy. J Child Neurol. 2006;21(11):939–945. - PubMed
    1. Healy SA, Im‐Bolter N, Olds J. Executive function and emotional, behavioral, and social competence problems in children with epilepsy. J Child Fam Stud. 2018;27(8):2430–2440.
    1. Steiger BK, Jokeit H. Why epilepsy challenges social life. Seizure. 2017;44:194–198. - PubMed
    1. Puka K, Smith ML. Long‐term outcomes of children with drug‐resistant epilepsy across multiple cognitive domains. Dev Med Child Neurol. 2021;63(6):690–696. - PubMed
    1. Austin JK, Smith MS, Risinger MW, McNelis AM. Childhood epilepsy and asthma: comparison of quality of life. Epilepsia. 1994;35(3):608–615. 10.1111/j.1528-1157.1994.tb02481.x - DOI - PubMed

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