Geffrey et al. (2026) — RNS in pediatric drug-resistant epilepsy (MGH)

Source

• Journal of Neurosurgery: Pediatrics 37(4):309-321, 2026. Massachusetts General Hospital cohort.

Why in corpus

Robust contemporary outcome data for responsive neurostimulation (RNS) in pediatric drug-resistant epilepsy — a contingent future option if Levi becomes medically refractory.

Key findings

• 32 patients (27 pediatric, 19 with ≥1 yr follow-up) treated with RNS.
• 12-month responder rate: 79% overall; 74% pediatric
• Median seizure reduction at 12 months: 78% (p=0.0003) overall; 73% (p=0.0097) pediatric
• Last follow-up responder rate: 92% overall; 89% pediatric
• Median seizure reduction at last follow-up: 91% (p=0.0002) overall; 90% (p=9.9×10⁻⁸) pediatric
• Super responders (≥90% reduction): 54% overall; 53% pediatric
• QoL improvements in cognition/school (p=0.0006 / 0.001), physical activities/ADLs (p=0.003 / 0.009), and seizures (p=1.8×10⁻⁶ / 1.3×10⁻⁵).
• Bilateral thalamic targeting was most common (24 of 32 patients).
• Robust outcomes attributed to patient-specific seizure-network targeting and rapid parameter escalation.

Levi-relevant takeaways

• Currently not on Levi's treatment path. Levi responded to the March 2026 steroid pulse and is not drug-resistant at this point.
• Most relevant if Levi becomes medically refractory and non-surgical candidate (which he currently is given no resectable lesion) — bilateral thalamic RNS becomes a concrete option.
• MGH is a reasonable reference center if RNS ever becomes indicated.
• QoL data supports that successful neuromodulation translates to cognitive and functional gains, not just seizure-count reduction — relevant framing for future surgical discussions.

Relationship to treatments workspace

• Adds weight to the contingent-neuromodulation tier of the treatments workspace, not a current-rank change.
• Specifies that bilateral thalamic targeting should be preferred over ANT-only in a DEE-SWAS context (consistent with Gonzalez-Martinez 2026 perspective).