Neuromodulation Strategies in Lennox‐Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium
Epilepsy Research Vol. 210
AUTHORS
Debopam Samanta 1 , Gewalin Aungaroon 2 , Anthony L Fine 3 , Cemal Karakas 4 , Michelle Y Chiu 5 , Puneet Jain 6 , Syndi Seinfeld 7 , Juliet K Knowles 8 , Ismail S Mohamed 9 , Carl E Stafstrom 10 , Tracy Dixon-Salazar 11 , Anup D Patel 12 , Sonam Bhalla 13 , Cynthia Guadalupe Keator 14 , Jorge Vidaurre 15 , Aaron E L Warren 16 , Renée A Shellhaas 17 , M Scott Perry 14
ABSTRACT
Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Neuromodulation techniques, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), have emerged as important treatment options for patients with LGS who do not respond adequately to antiseizure medications. This review, developed with input from the Pediatric Epilepsy Research Consortium (PERC) LGS Special Interest Group, provides practical guidance for clinicians on the use of these neuromodulation approaches in patients with LGS. We discuss patient selection criteria, expected seizure and non-seizure outcomes, potential complications, and device management considerations for each technique. The review also covers initiation and titration strategies, ongoing care requirements, and emerging data on combining multiple neuromodulation modalities. While all three approaches can reduce seizure frequency in patients with LGS, with commonly reported responder rates ranging from 50 % to 60 %, their impacts on cognition, behavior and quality of life are more variable. Careful patient selection, individualized programming, and long-term follow-up are essential to optimize outcomes with neuromodulation in this challenging patient population. Further research is needed to identify optimal candidates, determine the ideal timing during patients’ clinical course to consider neuromodulation, develop standardized outcome measures, and evaluate the comparative effectiveness and cost-effectiveness of different neuromodulation techniques for LGS.