Transcutaneous Vagus Nerve Stimulation Treatment of Epileptic Encephalopathy with Spike-and-Wave Activation in Sleep: A Prospective Cohort Study

ObjectiveThe purpose of this study was to investigate the efficacy of transcutaneous vagus nerve stimulation in pediatric patients with drug-resistant epileptic encephalopathy with spike-and-wave activation in sleep.MethodsWe prospectively investigate seven drug-resistant epileptic encephalopathy with spike-and-wave activation in sleep children who underwent transcutaneous vagus nerve stimulation for 12 weeks. The Chinese Revised Wechsler Intelligence Scale for Children (C-WISC) was used to assess cognitive changes before and after stimulation. Microstate parameters (mean duration, occurrence, and coverage) were obtained by quantifying each patient's electroencephalography (EEG) findings. Correlation analyses were used to assess the association between microstate parameters and cognitive scores. We analyzed the brain dynamics of the patients based on 4 categories of classical microstates using weighted phase lag index to construct a whole brain dynamic network. Finally, the brain network was quantitatively analyzed based on graph theory metrics (including global efficiency, local efficiency, and strength).ResultsA 12-week transcutaneous vagus nerve stimulation resulted in a significant increase in M/CIQ (Memory/Concentration Intelligence Quotient) and in seizure cessation in 57.14% of patients. The mean duration of microstate C was significantly reduced and enlarged the bidirectional predominance of microstate A and B, while weakening the directional predominance of microstates A, B, and D to C. The global efficiency, local efficiency, and strength of the microstate-based functional subnetwork were significantly reduced. And M/CIQ showed a strong correlation with the mean duration.SignificanceThis study revealed the efficacy of transcutaneous vagus nerve stimulation in improving the cognitive state of drug-resistant epileptic encephalopathy with spike-and-wave activation in sleep pediatric patients.