We aim to determine the safety and feasibility of RNS in children with refractory epilepsy.

Responsive neurostimulation (RNS) is a relatively recent addition to the epilepsy surgery armory and gained FDA approval in 2013 for use in adults with intractable focal epilepsy. Data for use of the RNS system in patients less than 18 years of age is limited.

A retrospective chart review was conducted for all patients who underwent RNS implantation at an urban tertiary children’s hospital. Demographics of the patients were obtained, including age at the time of implant, MRI findings, seizure onset zone identification, and RNS targets.

Chart review yielded 10 patients with successful RNS implantation from October 2018 to April 2021. One patient had a concurrent subdural collection evacuation at the time of RNS implant with a post-operative complication of infection at surgical site requiring explantation 2 months after procedure. One patient had a second RNS cannister placed successfully without complication, 3 years after initial RNS single cannister implant due to a broad epileptic network and continued seizures.

Placement of RNS is a feasible, relatively safe option for children as young as eight years with refractory epilepsy. Surgical site infection was a complication observed in one patient. Two cannister RNS placement is feasible for patients with a broad epileptogenic network or multifocal seizure onset zones.