Neuromodulation for Epilepsy & Seizure Disorders in Children

At the Pediatric Epilepsy Program, part of NYU Langone’s Comprehensive Epilepsy Center, surgeons from Hassenfeld Children’s Hospital at NYU Langone have performed more than 1,700 neuromodulation procedures, which use stimulating devices to control seizures, and are leaders in providing this treatment to children with epilepsy.

Vagus Nerve Stimulation

Surgeons use the vagus nerve to send signals to the brain to stop the electrical activity that causes seizures in children with epilepsy and seizure disorders. The vagus nerve travels from the brain stem, down the neck, and into the chest and abdomen. It influences the activity of many organs.

For this procedure, our experts implant a stimulating device the size of a silver dollar under the skin of the upper chest. A connecting wire runs under the skin from the stimulator to an electrode that is attached to the vagus nerve, which is accessible through a small incision in the neck.

After the stimulating device is implanted, a doctor programs it to deliver small electrical signals to the vagus nerve and into the brain at periodic intervals, usually for 30 seconds every 5 minutes. During follow-up visits, the doctor adjusts the settings, taking into account your child’s tolerance and seizure response.

A person with a stimulating device has some control over it. Each child receives a magnet that can activate the device. When your child or caregiver swipes the magnet over the device, it turns on and delivers a signal. This allows your child or a caregiver to try to stop a seizure when your child feels it coming on or the caregiver sees it begin.

The procedure to implant the device is relatively minor. It takes about one hour and requires general anesthesia. Most children return home the same day.

The device battery lasts for about five years, on average. Another minor surgery is required to replace it. Our physicians have also pioneered implantation of the device under the pectoralis muscle in the chest, making it cosmetically unnoticeable.

The vagus nerve stimulator is approved by the U.S. Food and Drug Administration for use in people who are age 12 or older and have focal epilepsy that has not improved with treatment. However, because this device has been shown to benefit people younger than age 12 and those who have other seizure disorders, the procedure is offered to them as well.

This treatment can work well in children with all types of epilepsy and seizure disorders for whom medications aren’t effective. However, it is particularly well suited for children with Landau-Kleffner syndrome. Other epilepsy syndromes—such as Ohtahara syndrome, Dravet syndrome, Angelman syndrome, tuberous sclerosis, and Lennox-Gastaut syndrome—also respond well to vagus nerve stimulation.

Responsive Neurostimulation

Our doctors may use a smart device that delivers responsive neurostimulation to the brain to help manage focal seizures. This treatment is tailored to the number and pattern of seizures.

Responsive neurostimulation may be an option when anti-seizure medications alone are not working to control focal seizure or if other types of surgery to control seizures are not an option.

Responsive neurostimulation tends to reduce the number of seizures people have, and benefits are seen over time. Patients continue to take anti-seizure medications as part of treatment.

Doctors surgically place the small, battery-powered, smart device, which is connected to two electrodes, in the skull, near the area where seizures originate.
 
The device records brain activity for about the first month after implantation. Doctors use this information to program the device so that it detects electrical activity that can lead to a seizure. The device immediately responds by delivering an electrical signal to the area of the brain where the seizure originates. This neurostimulation helps the brain waves to normalize, preventing a seizure. The device is active and ready to respond to seizures 24 hours a day.

Parents receive a remote monitor to collect and send data from their child’s device to a database that can be accessed remotely. Doctors review this information and adjust the device response as needed.

The procedure to implant the device can take up to three hours and requires general anesthesia. The device battery lasts for about 8 to 11 years. A minor surgical procedure is needed to replace the device.

Deep Brain Stimulation

For deep brain stimulation, our doctors implant a neurostimulator device connected to a tiny electrode in the brain to help manage focal seizures. The electrode carries electrical currents from the device directly to the brain to stop brain signals that cause seizures.

This treatment may reduce the number and severity of seizures. It may be recommended when anti-seizure medications alone have not improved seizures or if other types of surgery to control seizures are not an option.

Your child’s doctor programs the device in an outpatient clinic. The delivery of electrical currents is preset and is not responsive to electrical brain waves.

To place the device and electrode, our doctors perform two surgeries. For the first procedure, the surgeon places the electrode, which is attached to a wire, in the area of the brain where seizures occur. The surgeon passes the wire under the skin of the head, neck, and shoulder.

The second surgery occurs after the patient stays in the hospital overnight. The surgeon then connects the wire to a small battery pack that sends electrical impulses to the electrode in the brain. This device is implanted under the skin near the collarbone.

Both surgeries take several hours and are performed with general anesthesia. The battery for the device lasts up to five years. A minor surgical procedure is required to replace the battery.