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. 2024 Mar;14(3):e3452.
doi: 10.1002/brb3.3452.

A retrospective, naturalistic study of deep brain stimulation and vagal nerve stimulation in young patients

Deniz Yuruk  1 , Can Ozger  2 , Juan F Garzon  1 , Paul A Nakonezny  3 , Jennifer L Vande Voort  2 , Paul E Croarkin  2
Affiliations

A retrospective, naturalistic study of deep brain stimulation and vagal nerve stimulation in young patients

Deniz Yuruk et al. Brain Behav. 2024 Mar.

Abstract

Introduction: Invasive neuromodulation interventions such as deep brain stimulation (DBS) and vagal nerve stimulation (VNS) are important treatments for movement disorders and epilepsy, but literature focused on young patients treated with DBS and VNS is limited. This retrospective study aimed to examine naturalistic outcomes of VNS and DBS treatment of epilepsy and dystonia in children, adolescents, and young adults.

Methods: We retrospectively assessed patient demographic and outcome data that were obtained from electronic health records. Two researchers used the Clinical Global Impression scale to retrospectively rate the severity of neurologic and psychiatric symptoms before and after patients underwent surgery to implant DBS electrodes or a VNS device. Descriptive and inferential statistics were used to examine clinical effects.

Results: Data from 73 patients were evaluated. Neurologic symptoms improved for patients treated with DBS and VNS (p < .001). Patients treated with DBS did not have a change in psychiatric symptoms, whereas psychiatric symptoms worsened for patients treated with VNS (p = .008). The frequency of postoperative complications did not differ between VNS and DBS groups.

Conclusion: Young patients may have distinct vulnerabilities for increased psychiatric symptoms during treatment with invasive neuromodulation. Child and adolescent psychiatrists should consider a more proactive approach and greater engagement with DBS and VNS teams that treat younger patients.

Keywords: adolescent psychology; neuropsychiatrics; neurosurgery; psychiatry.

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Conflict of interest statement

Dr Croarkin has received research grant support from Neuronetics Inc, NeoSync Inc, and Pfizer Inc. He has received in‐kind support (equipment, supplies, and genotyping) for research studies from Assurex Health Inc., Neuronetics Inc., and MagVenture Inc. He has consulted for Engrail Therapeutics Inc., Myriad Neuroscience, Procter and Gamble, and Sunovion. Dr Vande Voort has received in‐kind support (supplies and genotyping) from Assurex Health Inc. The other authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Adjusted least‐squares mean (LSM) for Clinical Global Impression scale for illness severity (CGI‐S) neurologic scores. Between‐group differences were assessed with a linear mixed model for repeated measures. LSM values were adjusted for age, sex, and time‐varying CGI‐S psychiatric scores. No significant differences between groups were observed preoperatively (p = .79) or after treatment (p = .87). Neurologic symptoms improved after treatment for both groups (p < .001). A higher CGI‐S score indicates worse symptoms. Error bars show the standard error. CGI‐S indicates the Clinical Global Impression scale for illness severity; DBS, deep brain stimulation; VNS, vagal nerve stimulation.
FIGURE 2
FIGURE 2
Adjusted least‐squares mean (LSM) for Clinical Global Impression scale for illness severity (CGI‐S) psychiatric scores. Between‐group differences were assessed with a linear mixed model for repeated measures. LSM values were adjusted for age, sex, and time‐varying CGI‐S neurologic scores. No significant differences between groups were observed preoperatively (p = .06) or after treatment (p = .95). No significant improvement (decrease) was observed for psychiatric symptoms after DBS treatment (p = .97). However, patients receiving VNS had a significant worsening effect (increase) (p = .008). A higher CGI‐S score indicates worse symptoms. Error bars show the standard error. CGI‐S indicates the Clinical Global Impression scale for illness severity; DBS, deep brain stimulation; VNS, vagal nerve stimulation.
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