Add‐On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (<scp>ADVANCE</scp>): A Partially Randomized Patient Preference Trial
Hrishikesh Suresh, Karim Mithani, Nebras M. Warsi, Ayako Ochi, Hiroshi Otsubo, James M. Drake, James T. Rutka, Elizabeth N. Kerr, Mary Lou Smith, Sara Breitbart, Ivanna Yau, Lyndsey McRae, Vann Chau, Shelly K. Weiss, Puneet Jain, Elizabeth Donner, Alfonso Fasano, Carolina Gorodetsky, George M. Ibrahim
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.