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Add-On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially
Hrishikesh Suresh1,2,3, Karim Mithani1,2,3, Nebras Warsi1,2,3
1Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
Annals of Neurology
|June 1, 2024
Summary
For children with drug-resistant epilepsy, adding deep brain stimulation (DBS) to vagus nerve stimulation (VNS) significantly reduces seizures more than VNS alone. DBS may be considered earlier after VNS failure.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Epilepsy
Background:
- Vagus nerve stimulation (VNS) outcomes improve over time in pediatric drug-resistant epilepsy.
- The benefit of adding deep brain stimulation (DBS) versus continued VNS optimization is not well-established.
Purpose of the Study:
- To compare the efficacy of add-on deep brain stimulation (DBS) versus continued vagus nerve stimulation (VNS) optimization in children with drug-resistant epilepsy who did not respond to VNS.
Main Methods:
- Prospective, non-blinded, randomized patient preference trial.
- 18 children (aged 8-17 years) with drug-resistant epilepsy after at least 1 year of VNS.
- Comparison between add-on DBS and continued VNS optimization.
Main Results:
- Add-on DBS achieved significantly greater seizure reduction (51.9%) compared to VNS optimization (12.3%, p=0.047).
- Add-on DBS also led to less bothersome seizures (p=0.03).
- No significant change in quality of life was observed with either approach.
Conclusions:
- Deep brain stimulation (DBS) may be a valuable earlier treatment option for pediatric drug-resistant epilepsy when vagus nerve stimulation (VNS) is ineffective.
- This study suggests a potential shift in treatment paradigms for refractory epilepsy in children.
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