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A deep representation learning model to predict response to vagus nerve stimulation.

Hrishikesh Suresh1,2,3, Karim Mithani1,2,3, Vicki Li1,2

  • 1Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.

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|April 7, 2026
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A new deep learning model, VQ-VNS, predicts vagus nerve stimulation (VNS) success in pediatric epilepsy using MRI scans. This AI tool identifies patients likely to benefit, improving treatment decisions and reducing unnecessary surgeries.

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Area of Science:

  • Neuroscience
  • Artificial Intelligence
  • Medical Imaging

Background:

  • Pediatric epilepsy affects many children, with vagus nerve stimulation (VNS) being a common but inconsistently effective treatment.
  • Current methods cannot predict VNS outcomes, leading to surgeries without benefit for approximately half of pediatric patients.
  • Preoperative T1-weighted magnetic resonance imaging (T1w) shows potential for predicting VNS response but faces challenges due to high dimensionality.

Purpose of the Study:

  • To develop a predictive model for VNS treatment outcomes in pediatric epilepsy using preoperative T1w MRI data.
  • To overcome the limitations of traditional predictive modeling with high-dimensional imaging data.
  • To improve clinical decision-making for VNS implantation in children with epilepsy.

Main Methods:

  • A deep representation learning model, VQ-VNS, was developed to predict VNS response using preoperative T1w images (n=263).
  • The model was pre-trained on a large dataset of 7433 T1w images to learn compact anatomical representations.
  • Performance was evaluated on the largest pediatric VNS cohort (n=1046), comparing VQ-VNS predictions to clinical data-based predictions.

Main Results:

  • Presurgical clinical data showed poor predictive power for VNS response (AUC 0.54, p>0.99).
  • The VQ-VNS model accurately predicted VNS response with an AUC of 0.73 (p=0.007).
  • Model predictions highlighted disruptions in serotonin-rich brain regions and large-scale network connectivity in non-responders.

Conclusions:

  • VQ-VNS, a deep learning model, effectively predicts VNS outcomes in pediatric epilepsy using routine structural MRI.
  • The model offers biological interpretability, identifying network disruptions associated with non-response.
  • This approach enhances clinical decision-making, potentially improving treatment efficacy and reducing healthcare costs.