No abstract

Vagus nerve stimulation (VNS) is a safe and effective therapy for pediatric patients with drug-resistant epilepsy (DRE). However, in children with DRE, the effects of VNS on autistic behaviors remain controversial. We retrospectively collected data from 10 children with DRE who underwent VNS implantation and regular parameter regulation in three pediatric epilepsy centers, and completed the behavioral assessments, including the autistic behavior checklist and the child behavior checklist, at follow-ups 1 (mean 2.16 years) and 2 (mean 2.98 years). The 10 children maintained stable seizure control between the two follow-ups. Their autistic behaviors, especially in language, social and self-help, were reduced at follow-up 2 compared to follow-up 1 (p = 0.01, p = 0.01, respectively). Moreover, these improvements were not associated with their seizure control, whether it was positive or negative. These results suggested that the VNS had a positive effect on autistic behaviors, which provided a preliminary clinical basis that VNS may benefit to younger children with DRE comorbidity autism spectrum disorder (ASD).

Aims Vagus nerve stimulation (VNS) is a neuromodulation therapy for children with drug‐resistant epilepsy (DRE). The efficacy of VNS is heterogeneous. A prediction model is needed to predict the efficacy before implantation. Methods We collected data from children with DRE who underwent VNS implantation and received regular programming for at least 1 year. Preoperative clinical information and scalp video electroencephalography (EEG) were available in 88 children. Synchronization features, including phase lag index (PLI), weighted phase lag index (wPLI), and phase‐locking value (PLV), were compared between responders and non‐responders. We further adapted a support vector machine (SVM) classifier selected from 25 clinical and 18 synchronization features to build a prediction model for efficacy in a discovery cohort (n = 70) and was tested in an independent validation cohort (n = 18). Results In the discovery cohort, the average interictal awake PLI in the high beta band was significantly higher in responders than non‐responders (p < 0.05). The SVM classifier generated from integrating both clinical and synchronization features had the best prediction efficacy, demonstrating an accuracy of 75.7%, precision of 80.8% and area under the receiver operating characteristic (AUC) of 0.766 on 10‐fold cross‐validation. In the validation cohort, the prediction model demonstrated an accuracy of 61.1%. Conclusion This study established the first prediction model integrating clinical and baseline synchronization features for preoperative VNS responder screening among children with DRE. With further optimization of the model, we hope to provide an effective and convenient method for identifying responders before VNS implantation.

There is lack of prospective evidence regarding vagal nerve stimulator (VNS) in younger children with intractable epilepsy. Here, we report the outcomes of using VNS in two pre-school patients for pediatric intractable epilepsy (VNS-PIE) study. Medical treatment was ineffective in both the patients, and they underwent VNS implantation. Seizure frequency, score on the Gesell scale, and heart rate variability (HRV) were assessed following VNS therapy. After 6 months VNS treatment, the seizure frequency in the two patients decreased by 50% from that at baseline, based on the records in their epileptic diary. Video electroencephalography (EEG) examinations showed that abnormal fast waves diminished in the background in Patient 1, and captured seizure frequency in Patient 2 remarkably decreased. The adaptability, language, and individual and social interaction on their Gesell scales increased slightly, suggesting that VNS had a positive effect on the development of these two children. Moreover, the changes in the different HRV indices indicated improved cardiac autonomic function. In conclusion, these two cases indicated that VNS may not only be a superior therapy for pre-school children with intractable epilepsy, but also may exert a positive effect on their mental development and cardiac autonomic function.

Vagus nerve stimulation (VNS) is a neuromodulation therapy increasingly used for treating drug-resistant epilepsy. However, it remains to be determined which patients are best suited for the treatment, and it is difficult to predict the therapeutic effect before the implantation. Mutations in some genes could lead to epilepsy. Here we report two cases of pediatric patients with drug-resistant epilepsy treated by VNS therapy: Patient 1 with ARX mutation achieved good outcomes; Patient 2 with the CDKL5 mutation did not show improvement. Additionally, the therapeutic impact of VNS on brain networks was investigated, hoping to provide some empirical evidence for a better understanding of the mechanism of VNS treatment.