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Vagal nerve stimulation in children
1EEG and Pediatric Epilepsy Monitoring Unit, University of Pittsburgh School of Medicine, PA 15213-2583, USA.
Insights
Vagal nerve stimulation (VNS) shows promise for children with epilepsy refractory to medication. Further research is needed to define optimal patient selection and stimulation parameters for this growing pediatric population.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neurostimulation
Background:
- Vagal nerve stimulation (VNS) is an emerging therapy for medically refractory epilepsy.
- The NeuroCybernetic Prosthesis (NCP) was FDA-approved in 1997 for adolescents and adults.
- Pediatric use of VNS has increased, with initial data suggesting efficacy and safety in children unresponsive to antiepileptic drugs.
Purpose of the Study:
- To address key questions regarding the use of VNS in pediatric epilepsy.
- To guide the selection and treatment of children with refractory epilepsy using VNS.
Main Methods:
- Review of initial data from open-label, uncontrolled studies on pediatric VNS.
- Analysis of existing literature and clinical experience.
Main Results:
- VNS demonstrates potential efficacy and safety in children with refractory epilepsy.
- Further investigation is required to establish specific criteria and parameters.
Conclusions:
- VNS is a viable therapeutic option for pediatric refractory epilepsy.
- Key areas for future research include defining medical refractoriness, selection criteria, optimal stimulation parameters, and responsive seizure types/syndromes in children.
Abstract:
Vagal nerve stimulation is a new therapeutic option for patients with medically refractory epilepsy. The FDA approved the NeuroCybernetic Prosthesis (NCP) in July 1997 for use in adults and adolescents over the age of 12 years with medically refractory epilepsy. Most of the patients in the initial pilot studies and subsequent extended longitudinal and randomized controlled studies were adults. There were small numbers of children who received the NCP system. However, these were not part of controlled studies. As the system has had greater exposure in the United States and Europe, there are more children who are receiving vagal nerve stimulation (VNS). Initial data from open-label, uncontrolled studies suggest that VNS does have some efficacy and safety for those children with refractory epilepsy who have not responded to appropriate trials of antiepileptic drugs. The questions to be asked and answered are as follows: (1) When is a child medically refractory? (2) What are the criteria for selection for VNS? (3) Which seizure types or syndromes will benefit most from the treatment? and (4) What are the most effective and safe stimulation parameters, and do these vary depending on the seizure type?