Thiemo F. Dinger

Abstract Children with severe self-injurious behaviour (SIB) are at risk of permanent injury and lack effective treatment options. Neuromodulation of the nucleus accumbens (NAc), a key node in reward and behavioural regulation circuits, may directly modulate the drivers of SIB. We report long-term outcomes from a first-in-human, single-centre trial of deep brain stimulation (DBS) targeting the NAc in children and adolescents with profound autism and treatment-refractory SIB (NCT03982888).

We read with genuine interest the recent work of Bansal and colleagues, describing pediatric vagus nerve stimulation (VNS) outcomes from a single high-volume center.1 The authors are to be acknowledged for compiling an extensive dataset and for sharing insights spanning nearly two decades of clinical practice. Because pediatric VNS studies with long-term follow-up remain relatively uncommon, this contribution is an important addition to the literature.

Interrater agreement of retrospective chart reviews is highly dependent upon documentation quality. Agreement between clinicians and caregivers on seizure frequency ratings are generally poor. Coarser thresholds (50% or 90%) improve reliability at the cost of granularity. A higher seizure burden is associated with disagreements in absolute seizure frequency counts. Future studies should consider methods to mitigate disagreement in seizure frequency ratings.