Authors :
Presenting Author: Marthena Phan, BS – Nicklaus Children's Health System and Florida International University Herbert Wertheim College of Medicine
Ashley Howell, BS – Pediatric Neurosurgery Research Assistant, Pediatric Neurosurgery, Nicklaus Children's Hospital Brain Institute; Shelly Wang, MD, MPH, FRCSC, FAANS, FACS – Pediatric Neurosurgeon, Pediatric Neurosurgery, Nicklaus Children's Hospital Brain Institute; Marytery Fajardo, MD – Pediatric Neurologist, Pediatric Neurology, Nicklaus Children's Hospital Brain Institute; Puck Reeders, PhD – Senior Neuroscience Research Scientist, Nicklaus Children's Hospital Brain Institute
Rationale: Intractable epilepsy patients are likely to have concomitant comorbidities that can exacerbate symptoms, complicate treatment, further decrease quality of life, and increase risk of sudden unexpected death, all which are more pronounced in children than adults. For patients who do not qualify for resective surgery, vagus nerve stimulation (VNS) is an alternative surgical option. Neurodevelopmental comorbidities including autism, ADHD, depression, and anxiety have been studied in relation to VNS, but the distribution of these comorbidities and their relationship with VNS surgical outcomes is not well known.
Methods: We conducted chart reviews for 52 epilepsy VNS patients at Nicklaus Children’s Hospital with surgery ages ranging from 2 to 20 years (M = 11.69, SD = 4.73, 60% male). Of these patients, 20 had autism, eight had ADHD, six had anxiety and/or depression, and five had two to three comorbidities. Crosstab correlational testing was performed on SPSS to statistically compare variables to surgical outcomes.
Results: There was a significant correlation between having comorbidities (yes or no) and seizure duration change (reduced, no change, increased) at 6 months (Pearson’s R = 0.046). There were more cases of patients with comorbidities where seizure duration increased (12.5%) or who had no change in seizure duration (87.5%) compared to patients without comorbidities (increased: 0%, no change: 85%). There were more cases of seizure duration reduction in patients without comorbidities (15%) compared to patients with comorbidities (0%).
A significant correlation between the type of comorbidity (autism, ADHD, anxiety/depression, multiple comorbidities, no comorbidities) and seizure duration change at six months (Pearson’s R = 0.029) was also found. There was seizure duration reduction only in patients with no comorbidities (15%) and seizure duration increase only in patients with autism (20%). Patients with ADHD and multiple comorbidities reported no change while patients with anxiety/depression did not have a six month follow up.
Additionally, seizure focality (generalized or focal) was significantly correlated to seizure frequency change (reduced, no change, increased) at one year (Pearson’s R = 0.006). 83% of the patients had generalized epilepsy of which 13% had increased seizure frequency, 43% reported no change, and 44% had reduced seizure frequency. 17% of the patients had focal epilepsy of which 100% reported seizure frequency reduction. Of the patients with generalized epilepsy, 49% had comorbidities, and of the patients with focal epilepsy, 56% had comorbidities.
Conclusions: These results describe differences in VNS surgical outcomes between different neurodevelopmental comorbidities. Future research will further investigate underlying mechanisms of these comorbidities and neuropsychological characteristics in VNS surgical outcomes in a larger multicenter sample. Understanding the relationship between comorbidities, patient characteristics, and VNS responsiveness will aid in surgical decision-making regarding VNS implantation in pediatric epilepsy patients.
Funding:None