Association of Brain Network Perturbations With Response to Vagus Nerve Stimulation in Children With Drug-Resistant Focal Epilepsy

BACKGROUND AND OBJECTIVES: Vagus nerve stimulation (VNS) is the most common neuromodulation technique used to treat drug-resistant epilepsy (DRE) in children. Despite this, approximately half of those implanted do not realize a benefit and there are currently no means to preoperatively identify responders. Recent neuroimaging work has suggested that intrinsic differences in brain connectivity may explain some heterogeneity in VNS responsiveness. In the current work, we sought to study whether preimplantation functional network perturbations in relation to interictal epileptiform discharges (IEDs) are associated with VNS response in children with focal DRE. METHODS: tests at each time point, comparing responders and nonresponders, followed by temporal cluster-based correction for multiple comparisons. RESULTS: < 0.05), in the 500 milliseconds after IEDs. DISCUSSION: Our results provide evidence that connectivity of an intrinsic, anterior-dominant network is associated with response to VNS. Responders to VNS are characterized by stronger baseline connectivity of this network and greater resilience of this network to IED-related disruption.