Add-On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially Randomized Patient Preference Trial

Hrishikesh Suresh; Karim Mithani; Nebras Warsi; Ayako Ochi; Hiroshi Otsubo; James M Drake; James T Rutka; Elizabeth Kerr; Mary Lou Smith; Sara Breitbart; Ivanna Yau; Lyndsey McRae; Vann Chau; Shelly Weiss; Puneet Jain; Elizabeth Donner; Alfonso Fasano; Carolina Gorodetsky; George M Ibrahim

doi:10.1002/ana.26956

Add-On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially Randomized Patient Preference Trial

Ann Neurol. 2024 Aug;96(2):405-411. doi: 10.1002/ana.26956. Epub 2024 Jun 1.

Authors

Hrishikesh Suresh^{1

2

3}, Karim Mithani^{1

2

3}, Nebras Warsi^{1

2

3}, Ayako Ochi⁴, Hiroshi Otsubo⁴, James M Drake^{3

5}, James T Rutka^{3

5}, Elizabeth Kerr⁴, Mary Lou Smith^{2

4}, Sara Breitbart⁵, Ivanna Yau⁴, Lyndsey McRae⁴, Vann Chau⁴, Shelly Weiss⁴, Puneet Jain⁴, Elizabeth Donner⁴, Alfonso Fasano^{4

6

7

8

9}, Carolina Gorodetsky⁴, George M Ibrahim^{1

2

3

5

6}

Affiliations

¹ Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
² Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
³ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁴ Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁷ Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.
⁸ Division of Neurology, University of Toronto, Toronto, ON, Canada.
⁹ Krembil Brain Institute, Toronto, ON, Canada.

PMID: 38822686
DOI: 10.1002/ana.26956

Abstract

Outcomes following vagus nerve stimulation (VNS) improve over years after implantation in children with drug-resistant epilepsy. The added value of deep brain stimulation (DBS) instead of continued VNS optimization is unknown. In a prospective, non-blinded, randomized patient preference trial of 18 children (aged 8-17 years) who did not respond to VNS after at least 1 year, add-on DBS resulted in greater seizure reduction compared with an additional year of VNS optimization (51.9% vs. 12.3%, p = 0.047). Add-on DBS also resulted in less bothersome seizures (p = 0.03), but no change in quality of life. DBS may be considered earlier for childhood epilepsy after non-response to VNS. ANN NEUROL 2024;96:405-411.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Child
Deep Brain Stimulation* / methods
Drug Resistant Epilepsy* / therapy
Female
Humans
Male
Patient Preference*
Prospective Studies
Quality of Life
Treatment Outcome
Vagus Nerve Stimulation* / methods