Trends in Use of Neurostimulation Devices for the Treatment of Drug-resistant Epilepsy in Older Adults
Ankush Rakhit1, Eunsuh Cho1, Churl-Su Kwon2, Leah Blank1
1Neurology, Icahn School of Medicine at Mount Sinai, 2Columbia University
Objective:
To determine trends in use of neurostimulation devices for the treatment of drug-resistant epilepsy (DRE) in older adults.
Background:
Epilepsy has the highest adult incidence after age 50. In the US, multiple minimally invasive devices are now approved for epilepsy, including vagus nerve (VNS), responsive (RNS), and deep brain stimulation (DBS). Historically, epilepsy surgery is underutilized in older populations, but there has not been an evaluation of neurostimulation’s adoption in older adults since the approval of RNS.
Design/Methods:
Retrospective cohort study using the National Inpatient Sample (NIS). NIS is designed to be nationally representative of US hospital admissions when survey weights are applied. We identified hospitalizations occurring between January 2016 and December 2022 with an ICD-10-CM diagnosis code for seizure or epilepsy and a procedure code for VNS, RNS, or DBS. ANOVA and two-way ANOVA were used to compare means and trends in SPSS.
Results:
Older adults (≥55) had significantly lower use of VNS as compared to younger adults (18-54) (mean difference = -193, p<.001) and children (<18) (mean difference = -117, p<.001), and significantly lower use of RNS/DBS compared to younger adults (mean difference = -506, p<.001) but not children (mean difference = -50, p=0.22). There was no statistically significant trend for VNS use in any group. For RNS/DBS, younger adults and children experienced statistically significant increases in use (slope = 32.32, p=.005; slope = 8.571, p=.007), while older adults did not (slope = 0.89, p=0.89); the difference in trends was statistically significant (F = 9.179, p=.002).
Conclusions:
Younger adults and children have increased use of DBS/RNS since the introduction of RNS but not older adults. Overall, despite known underuse of epilepsy surgery, there appear to be no increases in neurostimulator use in older adults. This suggests specific strategies to improve access to epilepsy surgery in older adults are needed.
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