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Investigation of the effectiveness of vagus nerve stimulation for pediatric drug-resistant epilepsies secondary to nonaccidental trauma

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Abstract

Purpose

Epilepsy following non-accidental trauma (NAT) occurs in 18% of pediatric patients. About 33% of patients with epilepsy develop drug-resistant epilepsy. For these patients, vagus nerve stimulation (VNS) is a palliative treatment option. We aimed to investigate the effectiveness of VNS among pediatric NAT-related epilepsy patients compared to those with non-NAT-related epilepsy.

Methods

We performed an 11-year retrospective analysis of VNS implantations for drug-resistant epilepsy at UPMC Children’s Hospital of Pittsburgh. Patients were split into two groups: NAT vs. non-NAT. The primary outcome was the attainment of ≥ 50% seizure frequency reduction at 1-year post-VNS implantation. Fisher’s exact tests and Wilcoxon rank-sum tests were used to compare groups. Significance was assessed at the alpha = 0.05 level.

Results

This analysis included data from 370 pediatric VNS patients, of whom 9 had NAT-related epilepsy. NAT patients had a significantly younger age of epilepsy onset than non-NAT patients (0.3 years vs. 3.3 years). Otherwise, there were no statistically significant baseline differences between groups, including patient sex and quantity of antiseizure medications pre-VNS. Overall, 71% of NAT patients experienced ≥ 50% seizure frequency reduction compared to 48% of non-NAT patients (p = 0.269).

Conclusion

VNS may allow a higher proportion of pediatric patients with NAT-related epilepsy to achieve ≥ 50% seizure frequency reduction compared to other epilepsy etiologies. While the results of this study were not statistically significant, the effect size was large. Our results underscore the need for larger, multi-center studies to validate the effectiveness of VNS for this patient population.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Nallammai Muthiah, Brigit Joseph, Gregory Varga, Lena Vodovotz & Nikhil Sharma

  2. Department of Neurological Surgery, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Taylor J. Abel

Authors
  1. Nallammai Muthiah
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  2. Brigit Joseph
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  3. Gregory Varga
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  4. Lena Vodovotz
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  5. Nikhil Sharma
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Contributions

Conceptualization: Nallammai Muthiah, Taylor J. Abel; Methodology: Nallammai Muthiah, Brigit Joseph, Lena Vodovotz, Nikhil Sharma; Formal analysis and investigation: Nallammai Muthiah; Writing—original draft preparation: Nallammai Muthiah, Brigit Joseph; Writing—review and editing: Nallammai Muthiah, Brigit Joseph, Gregory Varga, Taylor J. Abel; Funding acquisition: n/a; Resources: Nallammai Muthiah, Taylor J. Abel; Supervision: Taylor J. Abel.

Corresponding author

Correspondence to Taylor J. Abel.

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Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the University of Pittsburgh approved this study (STUDY20070281).

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Informed consent was obtained from legal guardians or patients (when applicable). No identifying images or patient data are presented in this manuscript.

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The authors declare no competing interests.

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Muthiah, N., Joseph, B., Varga, G. et al. Investigation of the effectiveness of vagus nerve stimulation for pediatric drug-resistant epilepsies secondary to nonaccidental trauma. Childs Nerv Syst 39, 1201–1206 (2023). https://doi.org/10.1007/s00381-022-05817-9

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  • DOI: https://doi.org/10.1007/s00381-022-05817-9

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