Abstract：
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.
摘要：
丘脑神经调节已成为耐药性癫痫（DRE）的治疗选择，具有广泛和/或未定义的癫痫网络。虽然深部脑刺激（DBS）和反应性神经刺激（RNS）深度电极为成人DRE患者的丘脑电刺激提供了手段，丘脑神经调节在小儿癫痫中的应用仍然有限。为了解决这个差距，神经调节专家合作是在儿科癫痫研究联盟(PERC)癫痫手术特别兴趣小组内成立的。在这次专家审查中，总结了使用DBS和RNS进行丘脑神经调节方式的现有证据和建议，专注于前部（ANT），中心（CMN），和丘脑的髓核。到目前为止，根据关键的SANTE（刺激丘脑前核治疗癫痫）研究的结果，只有ANT的DBS被FDA批准用于成人患者的DRE治疗。其他丘脑神经调节适应症和目标的证据不太丰富。尽管缺乏证据,成人DRE患者对丘脑刺激的阳性反应导致其在儿科患者中使用。尽管由于小儿和成人癫痫之间的差异，谨慎是必要的，小儿神经调节的疗效和安全性与成人相当.的确,CMN刺激对于广泛性和弥漫性发作性癫痫越来越被接受，最近完成了一项随机试验。在欧洲进行的一项正在进行的临床试验中，对颞叶和后象限癫痫使用脉络膜刺激也越来越感兴趣。丘脑神经调节的未来有望彻底改变儿童癫痫的治疗前景。正在进行的研究，技术进步,和合作努力准备完善和改善丘脑神经调节策略，最终提高DRE儿童的生活质量。
