children's adaptive deep brain stimulation for epilepsy trial (cadet): pilot

Conditions: Epilepsy; Lennox-Gastaut Syndrome, Intractable

Summary: the cadet pilot will investigate the safety and feasibility of deep brain stimulation (dbs) to treat children with lennox-gastaut syndrome using a novel dbs device (picostim dyneumo-1). following a 30-day preoperative/baseline assessment phase, all children will have a neurosurgical procedure to implant the device. implantation will be followed by a 30-day phase of no stimulation (the device is off / inactive) and then a six-month phase of active stimulation (the device is on / active).

the cadet pilot will be a single-arm, multi-site, interventional clinical trial. this design has been chosen since this is a feasibility and safety trial in a small number of patients and thus does not primarily aim to determine efficacy. in this pilot clinical trial, four children with drug-resistant lgs will undergo bilateral cmn dbs. following the dbs insertion, all children will undergo one month of inactive ('off') dbs in order to allow the lesioning effect of electrode implantation to dissipate. thereafter, children will receive active ('on') dbs therapy with standard stimulation parameters for six-months. following the 'on' phase of the trial, the child will then transition into continuing clinical care and will have their stimulation parameters altered according to clinical evaluation.

Eligibility criteria:
inclusion criteria: children enrolled in this study must: 1. be 5-14 years of age at consent. 2. have a diagnosis of lennox-gastaut syndrome, as determined by: * slow (\<3.0hz) spike-and-wave pattern and/or fast wave pattern (tonic seizures) on eeg for at least six-months months prior to the enrolment into the baseline period * history of drop seizures (tonic, atonic, or tonic-clonic) for at least six-months prior to the enrolment into the baseline period 3. experience at least 10 seizures per month. 4. have tried and not responded to two or more antiseizure medications prior to enrolment. 5. be taking one or more anti-seizure medication(s) at a stable dose for at least the four weeks prior and have a parent/guardian(s) who is willing for their child's maintenance anti-seizure drugs to be unaltered for the trial duration. 6. if on a ketogenic diet, have been established on a stable ketogenic diet for at least 12 weeks prior to screening and the parent/guardian(s) to be willing for child to stay on a stable ketogenic for the duration of the trial. 7. have a parent/guardian(s) who is willing and able to comply with all the requirements of the study, including the completion of the seizure diary and periodic device charging. ------------------------------- exclusion criteria: children enrolled in this study must not: 1. have had prior deep brain stimulation insertion. 2. have an active ('on') vagus nerve stimulator (or active within the six months prior to the baseline period). 3. have abnormal thalamic anatomy detected on imaging that would render dbs either unsafe or unfeasible. 4. have a bleeding disorder. 5. have medical conditions/factors that would increase their anaesthetic risk to an unacceptable level. 6. have a nickel allergy 7. be pregnant 8. participate in contact sports

Keywords: deep brain stimulation neurostimulation neuromodulation epilepsy lennox-gastaut syndrome