Evidence map›Paper›PMID 41319125›Full record

ArticleEpilepsia2026

Do we agree on seizure reduction after vagus nerve stimulation? Interrater reliability of retrospective and prospective seizure frequency ratings from the CONNECTiVOS database.

Thiemo F Dinger, Karim Mithani, Hosni Abu Al-Hasan, Leeor Yefet, Farbod Niazi, Hrishikesh Suresh, Simeon M Wong, Venethia Danthine, Alexandre Berger, Ivanna Yau and 35 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

45 authors.

Thiemo F DingerDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-7009-9099
Karim MithaniDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-8094-3070
Hosni Abu Al-HasanDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Leeor YefetNeurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
Farbod NiaziNeurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
Hrishikesh SureshDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Simeon M WongNeurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0001-9070-0665
Venethia DanthineNeurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
Alexandre BergerNeurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
Ivanna YauDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-8549-9618
Lyndsey McRaeDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
James T RutkaDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Eisha A ChristianDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Shelly WeissDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Lauren ShamDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Elizabeth DonnerDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0003-1126-0548
Vann ChauDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Hanan Al-JohaniDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Flavio Leao LimaDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Arjun ChandranDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Ramazan JabbarliDepartment of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
Ulrich SureDepartment of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
Aristides HadjinicolaouDivision of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada.
Philippe MajorDivision of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada.
Alexander G WeilDivision of Neurosurgery, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada.
Jignesh TailorDepartment of Neurological Surgery, Indiana University School of Medicine, Bloomington, Indiana, USA.
Taylor J AbelDepartment of Neurological Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.ORCID https://orcid.org/0000-0002-5089-460X
Madison RemickDepartment of Neurological Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Emefa AkwayenaDepartment of Neurological Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Dewi SchraderDepartment of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Robert J BolloDepartment of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Matthew D SmythDepartment of Neurological Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
Diane AumDepartment of Neurological Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.ORCID https://orcid.org/0000-0001-5210-3595
Sean LewDepartment of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Shelly WangDepartment of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA.
Toba NiaziDepartment of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA.
Jeffrey S RaskinDivision of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Elysa WidjajaDepartment of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0003-0986-5476
Howard L WeinerDivision of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
Nisha GadgilDivision of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
Melissa A LoPrestiDepartment of Neurosurgery, University of Rochester Medical Center, New York, New York, USA.
Aria FallahDepartment of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.ORCID https://orcid.org/0000-0002-9703-0964
Elizabeth KerrDepartment of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.
Puneet JainDivision of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-6009-0859
George M IbrahimDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0001-9068-8184

Funding

Abe Bresver Chair in Fuctional Neurosurgery at the Hospital for Sick ChildrenCanadian Institutes for Health Research PJT159561
6 · The paper itself

Abstract

objectiveAlthough vagus nerve stimulation (VNS) is a well-established neuromodulation therapy for drug-resistant epilepsy, treatment outcomes remain heterogeneous. One possible source of variability lies in differing interpretations of seizure frequency ratings (SFRs). This study examined interrater reliability (IRR) in SFRs between (1) retrospective clinician-clinician chart reviews and (2) prospective caregiver-clinician reports, and explored sources of disagreement.

methodsData were collected from the CONNECTiVOS database. In the retrospective cohort (n = 254), two clinicians independently reviewed medical records and rated seizure frequency across multiple timepoints. In the prospective cohort (n = 214), caregivers and clinicians independently reported SFR in children treated with VNS. IRR was assessed across different measurement thresholds, and potential causes of disagreement were analyzed.

resultsClinician-clinician agreement in retrospective chart reviews was excellent (intraclass correlation coefficient [ICC] > .90, Cohen κ > .80), with 18.8% divergent ratings and 4.8% exceeding the reliable change index. Disagreement was significantly associated with higher mean seizure frequency at baseline (p = .004) and at postoperative timepoints (p < .001). In the prospective caregiver-clinician comparison, agreement for absolute seizure frequency was poor (ICC < .50), with discrepancies in 86.5% of cases, although only 1.8% were statistically significant. When rating pairs diverged, clinicians more often reported lower absolute seizure frequencies (p = .002) and greater relative seizure reductions (p = .023) and were more likely to classify patients as achieving a 90% reduction (p = .043). SIGNIFICANCE: This study highlights interrater variability in both retrospective and prospective SFR assessments, a finding systematically related to baseline seizure frequency. Coarser classifications (e.g., 50% or 90% seizure reduction) may improve agreement but reduce clinical nuance. Future efforts should focus on structured, patient-centered documentation and the development of objective outcome measures in VNS evaluation, particularly for children with high seizure burden.

Indexed as

Drug Resistant EpilepsySeizuresVagus Nerve StimulationAdolescentChildChild, PreschoolDatabases, FactualFemaleHumansMaleObserver VariationProspective StudiesReproducibility of ResultsRetrospective StudiesTreatment Outcomedata reportingdrug‐resistant epilepsyinterrater reliabilityneuromodulationvagus nerve stimulation

Identifiers

PMID41319125
PMCPMC13007852

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